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Gastroenterology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Patients with a pre-endoscopic Rockall score above 0 are associated with significant mortality and only those scoring 0 can be safely discharged. A full Rockall score of <3 is associated with 0.8% mortality, with a re-bleeding rate of 6.7%.
Case 26
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
The Rockall score is used to estimate mortality in patients with active upper gastrointestinal bleeding. There are two versions which can be calculated depending on whether the patient has had endoscopy yet or not. It is a well-validated score which is easy to use (Table 26.7).
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
Are you aware of any scoring systems to assess risk in these patients?Yes, the Rockall scoring system.Rockall score is based on age, degree of systemic shock, comorbidity, endoscopic diagnosis and presence of major stigmata of recent haemorrhage. Three levels of risk are suggested: Very low risk – safe for outpatient management, low risk of death (Rockall score 0)Low risk – need admission and early endoscopyHigh risk – need for resuscitation and urgent endoscopyPatients with an initial Rockall score of ≥1 should be considered for an early upper GI endoscopy.
Endoscopic cyanoacrylate injection therapy for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy
Published in Scandinavian Journal of Gastroenterology, 2023
Haijun Mou, Cheng Zou, Guoqing Shi, Sheng Wu, Rui Xie, Xuemei Liu, Jie Yang, Biguang Tuo
Forrest classification at emergency endoscopy is important prognostic factor for the final outcome of the patients with peptic ulcer bleeding. Rockall and Blatchford scoring systems have been used to predict clinical outcomes in patients with upper gastrointestinal bleeding. We further analyzed effects of Forrest classification, Rockall and Blatch scoring on rebleeding and all-cause mortality. Our patients were at high risk, with high baseline median Rockall score (6, IQR 5–8) and Blatchford score (12, IQR 10–14). The data showed that Forrest Ia and Ib had a higher rebleeding in comparison to Forrest IIa in perivascular injection patients, but there was no significant difference in all-cause mortality between Forrest classifications. Both high Rockall score and Blatchford score increased the risks of rebleeding and all-cause mortality, further supporting that Rockall scoring and Blockford scoring can serve as predictor of rebleeding and mortality for high-risk peptic ulcer bleeding.
Massive transfusion in upper gastrointestinal bleeding: a new scoring system
Published in Annals of Medicine, 2019
Yi-Chuan Chen, Chen-Ju Chuang, Kuang-Yu Hsiao, Leng-Chieh Lin, Ming-Szu Hung, Huan-Wen Chen, Shung-Chieh Lee
Convenience and rapid calculation are essential for a scoring system to be useful in predicting the need for MT, and accuracy is also important, since complications of transfusion can be severe [40,41]. Nevertheless, the components of these scoring systems are mainly based on the mechanisms of trauma, which is not fully applicable to patients with UGIB. The Rockall score and mGBS are both widely used scoring systems in predicting outcomes, such as mortality, further bleeding or the need for transfusion, interventions in patients with UGIB [19–24]. In our study, the new scoring system has a significantly higher AUROC than the Rockall score and mGBS (0.822 vs. 0.693, p < .001, 0.822 vs. 0.708, p < .001, respectively). The result of this study shows that the accuracy of the new scoring system is high (Figure 2) and easy to use by stratifying the risk of MT into three categories: low, normal and high risk (Table 4). To our knowledge, our current study is the first report that demonstrates a new scoring system to evaluate the need for MT to facilitate the initiation of the MT protocol in UGIB patients.
Systematic review and meta-analysis of risk scores in prediction for the clinical outcomes in patients with acute variceal bleeding
Published in Annals of Medicine, 2021
Ling Yang, Rui Sun, Ning Wei, Hong Chen
Quick and precise treatment can reduce mortality. Risk stratification could help recognize the high-risk patient, resulting in closer monitoring, faster response and improved prognosis. The consensuses proposed that risk stratification scores should be used as soon as possible in patients with AUGIB including ulcer and nonvariceal bleeding [4–6]. However, it is not until the endoscopy has been completed that the cause of bleeding would be known. As long as upper gastrointestinal bleeding is suspected, an urgent risk assessment should be done. Besides, AVB, as a much more dangerous condition than nonvariceal bleeding, is more in need of stratification scores. Up to now, several risk scores have been invented. The most widely used scores for predicting upper gastrointestinal bleeding are the Glasgow-Blatchford score (GBS), the Rockall score and the AIMS65 score. In 2000, the GBS was developed and validated to predict in-hospital rebleeding, death and the need for intervention [7]. The Rockall score was created in 1996 to predict death and rebleeding [8], including clinical Rockall score and full Rockall score. Saltzman et al. developed and validated the AIMS65 score in 2011 to predict in-hospital death [9]. However, the three risk scores were validated and compared mostly in AUGIB patients, especially acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). Patients with variceal bleeding were excluded or only accounted for a small part. The best score predicting the prognosis of AVB patients remains unclear. Another two predictive scores for patients with chronic liver disease are also gradually used in predicting variceal bleeding. The Child–Pugh score (CTP) is a valuable tool for determining the prognosis of chronic liver disease, especially cirrhosis [10]. Another scoring system for assessing the seriousness of the chronic liver disease is the model for end-stage liver disease (MELD). It is commonly used to estimate mortality in patients who had a transjugular intrahepatic portosystemic shunt (TIPS) procedure [11] and prioritize for receipt of a liver transplant [12]. Previous studies had reported the two staging systems’ predictive abilities in AVB patients’ outcomes, but which could reflect the prognosis more accurately remained controversial [13,14]. We aim to conduct a systematic review of the predictive value of GBS, AIMS65, Rockall (clinical Rockall score and full Rockall score), CTP and MELD in risking stratify AVB patients for mortality and rebleeding within three months after the initial bleeding.