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Triage of inter-hospital transfers for patients with acute upper gastrointestinal bleeding, in response to Beaton et al
  1. Mark Jacunski1,
  2. Hannah Walton1,
  3. Victoria Moffat2,
  4. Nicholas I Church1,
  5. Rahul Kalla1
  6. Edinburgh Gastrointestinal Audit and Research (EGAR) Collaborative
  1. 1The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2St John’s Hospital, Livingston, UK
  1. Correspondence to Dr Mark Jacunski; mark.jacunski{at}nhs.scot

https://doi.org/10.1136/flgastro-2024-102985

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    We read with interest the recent article by Beaton et al on improving triage in upper gastrointestinal bleeding (UGIB).1 A pertinent issue not included in this study is triage and transfer of patients with UGIB from sites without provisions for 24-hour endoscopy to tertiary out-of-hours (OOH) centres. The decision to transfer can be clinically and logistically challenging; hence, many centres use scoring systems to aid decision-making.

    A large prospective study comparing various scoring systems identified that Glasgow–Blatchford Scores (GBS) of greater than six are the most accurate predictor of requiring endoscopic intervention.2 Most other scoring systems were designed to predict mortality but without examining endoscopy timing, including the Rockall score3 or AIMS65.4 Other scores such as C-WATCH5 can predict the need for aspects of inpatient management, such as transfusion, but not urgent endoscopy. Identifying patients who are at high risk of early deterioration remains bereft of clinical decision aids.

    We performed a retrospective review for all patients transferred from a peripheral hospital to …

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    Footnotes

    • Collaborators Edinburgh Gastrointestinal Audit and Research Collaborative.

    • Contributors RK, VM, HW, and NC contributed to project design. The EGAR collaborative consists of investigators contributing to local project coordination and have contributed to project design. VM, HW and MJ collected data. HW and MJ performed the analysis. MJ, HW and RK wrote the manuscript. All authors reviewed the manuscript and approved submission. RK is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.