Derya ÜNAL, Süleyman COŞGUN
Turkish Journal of Internal Medicine - 2026;8(1):82-89
Objective: Upper gastrointestinal bleeding (UGIB) is a critical gastroenterological emergency originating from the esophagus, stomach, or duodenum that requires rapid risk stratification in the emergency department [1,2]. A substantial proportion of patients evaluated in secondary care hospitals are referred to tertiary centers due to potential endoscopic intervention needs. However, not all referred patients require advanced-center management. Methods: Ethical approval was obtained from Kütahya Health Sciences University (No: 2025/11-26, Date: 15.09.2025). This retrospective, descriptive, and analytical study evaluated 108 patients (107 included in the final analysis) referred from secondary care facilities to a tertiary hospital with a preliminary diagnosis of gastrointestinal bleeding between April 2024 and February 2025. Glasgow-Blatchford Scores (GBS) were calculated using clinical, laboratory, and endoscopic findings. Data normality was assessed via Kolmogorov-Smirnov and Shapiro-Wilk tests. Since parameters exhibited a non-normal distribution, the non-parametric Mann-Whitney U test compared referral requirements, endoscopy needs, and GBS. Statistical significance was set at p<0.05. Receiver Operating Characteristic (ROC) curve analysis predicted referral decisions, and linear regression evaluated associated factors. Results: The cohort comprised 38 females and 69 males, with a mean age of 67.6+/-1.6 years. The mean GBS was 8.89+/-3.6. Risk stratification categorized 2% of patients into the low-risk group, 20% into the moderate-risk group, and 78% into the high-risk group. Retrospective analysis at the tertiary hospital revealed that approximately 20% of these referrals involved patients who could have been safely managed at their initial secondary care centers. Conclusion: Although there is no study in the literature that directly measures the rates of unnecessary referrals or hospitalizations, patients who could be safely discharged according to the GBS result were evaluated [3]. Studies indicate that a GBS cut-off value of 1 lowers the yield of patients who can be safely managed as outpatients [4]. This tertiary center analysis demonstrates that GBS serves as an objective tool to review referral indications and mitigate unnecessary transfers, potentially reducing patient burden and healthcare costs. Although our economic analysis was strictly limited to baseline transfer expenses, these unnecessary procedures impose additional financial and operational burdens on the healthcare system.
