The Blatchford Score is an useful index in the management of Mallory-Weiss tear and gastrointestinal bleeding Experience from an urban Community Hospital

Objectives : The purpose of this study was to determine the utility of individual clinical parameters as well as a composite index like the Blatchford score in predicting the need for endoscopic inter- vention and prognosticating the out come in patients with Mallory Weiss tear presenting with gastrointestinal bleeding. Methods : We retrospectively reviewed our endoscopy database and our EMR system to identify patients with Mallory Weiss tear and collect relevant data. Results : A total of 38 cases with Mallory-Weiss tear were identi- fied at our center over a 5 year period. Thirty-two patients present- ed with gastrointestinal bleeding constituting 3.1% of all cases pre- senting with upper gastrointestinal bleeding. Nine (28%) of 32 patients were found to have active bleeding or stigmata of recent bleeding at endoscopy and required endoscopic therapy. The Blatchford score ranged from 0 to 11 in the patients with gastro- intestinal bleeding. Nine patients had a Blatchford score < 6 (four 0, five 1-4) while 23 patients had a score > 6. None of the patients with a score < 6 required endoscopic intervention or a blood trans- fusion while 9 (39%) patients with a score > 6 required endoscopic intervention and 17 (74%) required a blood transfusion. Length of stay was significantly longer in patients with a score > 6. Conclusions : The Blatchford score can be a useful index to risk stratify patients with Mallory Weiss tear who present with gastro- intestinal bleeding with regards to hospital admission and identify- ing patients who warrant urgent endoscopic intervention, require blood transfusion and are likely to have a longer length of stay. (Acta gastroenterol. belg., 2012, 75, 432-437).