Clinical profile, etiology, and diagnostic accuracy of a UGIB etiology score in patients presenting to the emergency department

Abstract

Introduction: Upper gastrointestinal bleeding (UGIB) is one of the commonest causes of Emergency Department (ED) visits and is associated with high mortality. Early identification of etiology is essential as it guides initial pharmacological management before endoscopy. However, endoscopy is not readily available in all centers. This study aimed to describe clinical profile and etiology of UGIB and to assess the accuracy of validated UGIB etiology score in predicting variceal bleeding.
Method: This prospective observational study included patients presenting to ED with UGIB over one-year period at tertiary care center with endoscopy facilities. Clinical features, laboratory parameters, and endoscopic findings were recorded. UGIB etiology predicted by the scoring system was compared with endoscopic diagnosis.
Result: A total of 49 patients were included, with a mean age of 49.5 years. Variceal bleeding was observed in 63.3% of cases and non-variceal bleeding in 36.7%. Anemia was present in 81.6% of patients at presentation, and 57.1% had red nasogastric aspirate. Hepatomegaly was noted in 26 patients and splenomegaly in 18 patients. According to the UGIB etiology score, 31 patients were classified as variceal and 18 as non-variceal. Endoscopy confirmed variceal bleeding in 30 of the 31 predicted cases. The score showed a sensitivity of 90.9%, specificity of 93.8%, positive predictive value of 96.8%, and negative predictive value of 83.3%.
Conclusion: UGIB Etiology Score correctly identified 30 of 33 patients with variceal bleeding and correctly classified 15 of 16 patients with non-variceal bleeding in comparison with the endoscopic findings.