The goal of this prospective observational study is to compare the Glasgow-Blatchford Score (GBS), AIMS65, and pre-endoscopic Rockall Score in predicting outcomes among patients with upper gastrointestinal bleeding (UGIB). The main questions it aims to answer are: Which score best predicts in-hospital mortality and need for clinical intervention? Which score best predicts rebleeding and length of hospital stay? Researchers will compare the predictive performance of the three scoring systems. Participants will have their clinical and laboratory data collected and will be followed during their hospital stay for relevant outcomes.
Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with significant morbidity and mortality. Early risk stratification is essential to guide timely intervention, prioritize endoscopy, optimize resource allocation, and identify low risk patients suitable for conservative or outpatient management. Several pre-endoscopic scoring systems, including the Glasgow-Blatchford Score (GBS), AIMS65, and the pre endoscopic Rockall Score, are commonly used; however, their their comparative performance varies across populations, and local data from Nepal remain limited. This prospective observational study aims to compare the predictive accuracy of GBS, AIMS65, and pre-endoscopic Rockall Score in patients presenting with upper gastrointestinal bleeding at a tertiary care hospital in Nepal over a six-month study period. The primary outcomes will include in-hospital mortality and need for clinical intervention (blood transfusion, endoscopic therapy, surgery, or ICU admission). Secondary outcomes will include rebleeding and length of hospital stay. Predictive performance will be evaluated using receiver operating characteristic curve analysis. The findings of this study are expected to identify the most appropriate pre-endoscopic risk stratification tool for UGIB in the Nepalese context, thereby supporting early clinical decision-making and improving patient management.
Study Type
OBSERVATIONAL
Enrollment
100
Kathmandu Medical College and Teaching Hospital
Kathmandu, Bagmati, Nepal
Requirement for Blood Transfusion Within 24 Hours
Proportion of participants requiring blood transfusion (packed red blood cells or Whole blood) within 24 hours of presentation.
Time frame: Within 24 hours of hospital admission
Rate of Intensive Care Unit (ICU) Admission
Proportion of participants requiring admission to the ICU due to severe upper gastrointestinal bleeding or hemodynamic instability.
Time frame: through study completion, an average of 7 days
In-Hospital Rebleeding Rate
Proportion of participants experiencing recurrent bleeding (characterized by fresh hematemesis, melena with hemodynamic instability, or persistent drop in hemoglobin (\>2gm/dl) after index hemostasis during the index admission.
Time frame: through study completion, an average of 7 days
Early Mortality (Within 48 Hours)
Proportion of all-cause patient deaths occurring within 48 hours of initial presentation.
Time frame: Within 48 hours of hospital admission.
Overall In-Hospital Mortality
Proportion of all-cause patient deaths occurring during the index hospital stay.
Time frame: through study completion, an average of 7 days
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