Comparison of Risk Assessment Tools in Patients Diagnosed With Upper Gastrointestinal Bleeding in the Emergency Department: A Retrospective Cohort Study

Background:Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening condition in the emergency department (ED), and accurate risk stratification is essential for guiding management decisions.The comparative performance of disease-specific scores (Glasgow-Blatchford Score [GBS] and AIMS65) and general early warning scores (National Early Warning Score 2 [NEWS2] and Modified Early Warning Score [MEWS]) in predicting ED-specific outcomes remains unclear. Material/Methods:This retrospective cohort study was conducted in a tertiary-care ED between January 1, 2021, and December 31, 2022.Adult patients ( 18 years) with endoscopically confirmed non-traumatic UGIB were included.We extracted demographic data, clinical findings, endoscopic findings, and transfusion requirements from electronic medical records.We calculated GBS, AIMS65, NEWS2, and MEWS.The primary outcome was the need for red blood cell (RBC) transfusion in the ED.The secondary outcome was an adverse ED outcome. Results:A total of 905 patients were included (mean age 63 ± 18 years; 65.6% female).RBC transfusion was required in 41.0% of patients, and 40.7% experienced adverse ED outcomes.Median GBS, NEWS2, and MEWS scores were significantly higher in patients requiring transfusion and in those with adverse ED outcomes (all P < 0.001).AIMS65 showed the lowest discriminative performance, it demonstrated poor predictive ability for both RBC transfusion (AUC 0.514, 95% CI 0.475-0.552)and adverse ED outcomes (AUC 0.525, 95% CI 0.468-0.563).For predicting RBC transfusion, GBS demonstrated the highest discriminative performance (AUC 0.795), followed by NEWS2 (0.601), MEWS (0.570), and AIMS65 (0.514).Similarly, for predicting adverse ED outcomes, GBS showed the highest AUC (0.664), followed by NEWS2 (0.655), MEWS (0.623), and AIMS65 (0.525). Conclusions:Among the scores assessed in this study cohort, GBS showed the highest discriminative point estimates for predicting both RBC transfusion requirement and adverse ED outcomes, although overall predictive accuracy was modest, and AIMS65 showed no significant association with either outcome.