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Does This Patient Have a Severe Upper Gastrointestinal Bleed?

Methodology: 2.5/5    
Usefulness: 2.5/5 
Srygley FD, Gerardo CJ, Tran T, Fisher DA.
JAMA. 2012 Mar 14;307(10):1072-9


This recent installment of JAMA’s Rational Clinical Examination series found that a history or physical exam positive for melena, a nasogastric lavage with blood or coffee grounds, or a BUN:Creatinine ratio > 30 increased the likelihood of an upper GI bleed while a Blatchford score of 0 significantly decreased the likelihood that an upper GI bleed would require urgent intervention. Unfortunately this systematic review and meta-analysis had a surprisingly poor search strategy and lack of sensitivity analysis.   JC attendees agreed that despite the authors’ endorsement of the Blatchford scoring system, it alone is not sufficient enough to be used for safely discharging patients home and recent studies that have attempted to externally validate this scoring system would support this notion. 

By Dr. Tighe Crombie

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