Clinical decision instruments that predict short-term interventions and outcomes are fabulous things – precisely the sort of instruments that help Emergency Department physicians decide who will benefit from hospitalization.
This is the Glasgow Blatchford Score, a decision instrument applicable to presentations for upper gastrointestinal bleeding. It has been “improved” by physicians from Kaiser, who have performed addition by subtraction – eliminating variables without a significant change in performance. The original score has eight clinical features – the “improved” version has five, dropping chronic disease, melena, and syncope from the criteria. Despite this, the AUC for therapeutic endpoints as well as for rebleeding and mortality is no different than the original score – at 0.85 and 0.83, respectively.
It is only a 200 patient cohort, and they don’t break down exactly how many patients were in each quartile of possible modified GBS, but essentially, a score of 0 or 1 means <5% chance of needing a clinical intervention, scores of 2-6 about 20% need an intervention, and anything above that is 70% chance of intervention. The incremental improvement over regular physician judgement is not examined, but, more objective evidence is always better.