Vários escores de risco foram desenvolvidos e validados, mas cada um deles demonstrou ter o desempenho mais preciso para prever desfechos específicos: por exemplo, mortalidade, risco de ressangramento, necessidade de transfusão ou necessidade de terapia cirúrgica ou endoscópica. As diretrizes internacionais, americanas e europeias sobre hemorragia digestiva alta recomendam apenas o escore de sangramento de Glasgow-Blatchford (GBS) para identificar, com alta certeza, pacientes de risco muito baixo que podem ser tratados com segurança como pacientes ambulatoriais.[39]Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.
https://journals.lww.com/ajg/fulltext/2021/05000/acg_clinical_guideline__upper_gastrointestinal_and.14.aspx
http://www.ncbi.nlm.nih.gov/pubmed/33929377?tool=bestpractice.com
[40]Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.
https://www.acpjournals.org/doi/full/10.7326/M19-1795
http://www.ncbi.nlm.nih.gov/pubmed/31634917?tool=bestpractice.com
[43]Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021 Mar;53(3):300-32.
https://www.esge.com/endoscopic-diagnosis-and-management-of-nonvariceal-upper-gastrointestinal-hemorrhage-esge-update-2021
http://www.ncbi.nlm.nih.gov/pubmed/33567467?tool=bestpractice.com
Escore de sangramento de Glasgow-Blatchford
O GBS (escore pré-endoscópico) é calculado utilizando os seguintes parâmetros: ureia, hemoglobina, pressão arterial sistólica, pulso, melena, história ou evidências de doença hepática e doença arterial coronariana.[38]Stanley AJ, Ashley D, Dalton HR, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009 Jan 3;373(9657):42-7.
http://www.ncbi.nlm.nih.gov/pubmed/19091393?tool=bestpractice.com
[44]Masaoka T, Suzuki H, Hori S, et al. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol. 2007 Sep;22(9):1404-8.
http://www.ncbi.nlm.nih.gov/pubmed/17716345?tool=bestpractice.com
[45]Srirajaskanthan R, Conn R, Bulwer C, et al. The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage. Int J Clin Pract. 2010 Jun;64(7):868-74.
http://www.ncbi.nlm.nih.gov/pubmed/20337750?tool=bestpractice.com
Os pacientes com um escore de 0 a 1 são classificados como de risco muito baixo, o que indica uma taxa de falsos-negativos ≤1% para necessidade de intervenções hospitalares ou morte.[39]Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.
https://journals.lww.com/ajg/fulltext/2021/05000/acg_clinical_guideline__upper_gastrointestinal_and.14.aspx
http://www.ncbi.nlm.nih.gov/pubmed/33929377?tool=bestpractice.com
[40]Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.
https://www.acpjournals.org/doi/full/10.7326/M19-1795
http://www.ncbi.nlm.nih.gov/pubmed/31634917?tool=bestpractice.com
[43]Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy. 2021 Mar;53(3):300-32.
https://www.esge.com/endoscopic-diagnosis-and-management-of-nonvariceal-upper-gastrointestinal-hemorrhage-esge-update-2021
http://www.ncbi.nlm.nih.gov/pubmed/33567467?tool=bestpractice.com
Os pacientes com um escore ≥2 devem ser internados imediatamente e receber uma endoscopia em até 24 horas.[1]Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf). 2023 Mar 20;11:goad011.
https://academic.oup.com/gastro/article/doi/10.1093/gastro/goad011/7081277
http://www.ncbi.nlm.nih.gov/pubmed/36949934?tool=bestpractice.com
[39]Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.
https://journals.lww.com/ajg/fulltext/2021/05000/acg_clinical_guideline__upper_gastrointestinal_and.14.aspx
http://www.ncbi.nlm.nih.gov/pubmed/33929377?tool=bestpractice.com
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Escore de Blatchford para sangramento gastrointestinal
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