A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management

Almela, Pedro; Benages, A; Peiró, Salvador; Añón, R; Pérez, Manuel Asensi; Peña, Andrés; Pascual, Isabel; Mora, Francisco

doi:10.1016/s0016-5107(04)00362-1

Cited by 32 publications

(16 citation statements)

References 45 publications

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“…Multiple scoring systems in UGIB, e.g. the Rockall score [21] , Baylor bleeding score [22] , Blatchford score [20] , Cedars-Sinai score [23] and other scoring systems [27] including a scoring system in Thai patients [28] were also developed for these purposes. In contrast, the present study aimed to determine clinical parameters for use in a scoring system to predict the types of UGIB.…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Pongprasobchai¹,

Nimitvilai²,

Chasawat³

et al. 2009

WJG

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AIM:To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding (UGIB) Etiology Score for predicting the types of UGIB and validate the score. METHODS:Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS:Among 261 patients with UGIB, 47 (18%) had variceal and 214 (82%) had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease (OR 22.4, 95% CI 8.3-60.4, P < 0.001), red vomitus (OR 4.6, 95% CI 1.8-11.9, P = 0.02), and red nasogastric (NG) aspirate (OR 3.3, 95% CI 1.3-8.3, P = 0.011).The UGIB Etiology Score was calculated from (3.1 × previous diagnosis of cirrhosis or signs of chronic liver disease) + (1.5 × red vomitus) + (1.2 × red NG aspirate), when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in another set of 195 UGIB cases (46 variceal and 149 non-variceal bleeding). The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION:The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

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Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Pongprasobchai¹,

Nimitvilai²,

Chasawat³

et al. 2009

WJG

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“…5 A variety of risk scoring systems for upper GI bleeding have been introduced to predict the need for intervention or the likelihood of death 2,[6][7][8][9] and to develop an optimal management strategy. Risk scores based on clinical data would be more helpful for emergency physicians when urgent endoscopy is not available.…”

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confidence: 99%

Comparison of the Glasgow‐Blatchford and AIMS65 Scoring Systems for Risk Stratification in Upper Gastrointestinal Bleeding in the Emergency Department

Yaka

Yılmaz

Doğan

et al. 2014

Academic Emergency Medicine

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ObjectivesThe aim of this study was to compare the performance of the Glasgow‐Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes.MethodsData were collected prospectively over a 2‐year period in the emergency department of a university hospital. Adult patients with upper GI bleeding from either variceal or nonvariceal sources were included. Composite clinical outcomes consisted of a need for surgical or endoscopic intervention, rebleeding, intensive care unit admission, or in‐hospital mortality. Patients who required blood transfusions or suffered composite clinical outcomes were considered high‐risk patients. Glasgow‐Blatchford score (GBS) and AIMS65 score were calculated for each patient. The sensitivity and specificity of the scoring systems were calculated. The areas under the receiver‐operating characteristic curve (AUC) of the scores were compared.ResultsThere were 254 patients in the study, of whom 163 (64.2%) were men. The median age was 61 years (interquartile range = 45 to 72 years). Among the patients, 211 (83.1%) underwent endoscopy, of whom 49 (19.3%) required endoscopic intervention to achieve hemostasis. Five (2%) patients required surgical intervention. Rebleeding was observed in 33 (13%) patients. A total of 143 (56.3%) patients received blood transfusions. A total of 152 (59.8%) were defined as high risk. Eighty‐one (31.9%) experienced at least one component of the composite clinical outcomes, 18 (7.1%) of whom suffered in‐hospital mortality. A GBS of 0 was observed in 16 patients (6.3%) in the study group. Two of these were high‐risk patients. A total of 101 (39.8%) patients had AIMS65 scores of 0. Thirty‐four of these were high‐risk patients. A GBS of 0 had higher sensitivity than an AIMS65 score of 0 (98.68% vs. 77.6%). The negative predictive values of the GBS and AIMS65 of 0 were 87.5 and 66.3%, respectively. The GBS and AIMS65 were similar with regard to the composite outcome prediction, with AUCs of 0.795 (95% confidence interval [CI] = 0.74 to 0.843) and 0.746 (95% CI = 0.688 to 0.798), respectively (p = 0.137). The scores were also similar with respect to predicting in‐hospital mortality (AUCs of 0.85 vs. 0.81; p = 0.342). The GBS was superior to the AIMS65 in identifying high‐risk patients, with AUCs of 0.896 (95% CI = 0.85 to 0.93) and 0.771 (95% CI = 0.714 to 0.821; p < 0.001), respectively. The GBS was also more accurate than the AIM65 in predicting the need for blood transfusions (AUCs of 0.904 vs. 0.796; p < 0.001) and interventions (AUCs of 0.727 vs. 0.647; p = 0.05).ConclusionsThese results suggest that the GBS has superior sensitivity relative to the AIMS65 in identifying patients who were not likely to require interventions, including emergency endoscopy. Additional work to determine the use in real‐time decision making may be warranted and helpful in providing guidance to clinicians.

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“…Patients with a "good outcome" were defined as those alive, without persisting or recurrent bleeding, and patients who did not need surgery (• " Table 2) [30,31,33]. Consistent variables predicting good outcome included no co-morbid diseases, normal blood pressure, and no fresh blood after performing nasogastric aspiration (• " Table 3).…”

Section: Composite Endpointmentioning

confidence: 99%

“…Poor outcome was the primary endpoint in four studies [27 -29, 34]. Villanueva et al [28], Almela et al, [33], and Imperiale et al [34] developed risk scores for upper gastrointestinal bleeding based on pre-and post-endoscopic variables. Kollef Step 3 Impact analysis Step 2 Validation Original article 733 gastrointestinal bleeding.…”

Section: Composite Endpointmentioning

confidence: 99%

Prediction scores in gastrointestinal bleeding: a systematic review and quantitative appraisal

et al. 2012

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Background and study aims: Several algorithms predicting outcomes in acute gastrointestinal bleeding have been developed over the past three decades. These algorithms differ substantially and therefore the aim of the current study was to conduct a systematic review to compare their predictive performance and methodological quality in gastrointestinal bleeding. Methods: A PubMed literature search was performed up to 1 July 2011.?All studies reporting prediction scores in gastrointestinal bleeding were included. Studies were analyzed for predictive performance, and a quality appraisal of these rules was performed for which a score range of 0 (lowest) to 29 (highest) was used. Results: A total of 372 studies were identified, of which 16 were eligible for inclusion. The studies evaluated different outcomes: mortality (n?=?5), rebleeding (n?=?2), intervention required (n?=?2), or a combination (n?=?7). The predictive performance of the identified prediction scores varied between an area under the curve of 0.71???0.92 (if given). The mean overall quality rating was 17 (SD 4.0, range 9???25). Major methodological shortcomings were the absence of validation and absence of impact analyses. Eight of 16 scores (50?%) were determined ?easy to use,? and five scores (31?%) reported some type of action based on the results. Conclusion: Substantial heterogeneity in outcomes and results was seen in the 16 identified prediction scores. Moreover, the methodological quality was suboptimal in most studies. However, we suggest that clinicians should use the ?best available? scores according to performance and quality, which are the Blatchford score to assess the need for intervention, and the scores of Villanueva et al. for poor outcome, Guglielmi et al. for rebleeding, and Chiu et al. for mortality risk.

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A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management

Cited by 32 publications

References 45 publications

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

Comparison of the Glasgow‐Blatchford and AIMS65 Scoring Systems for Risk Stratification in Upper Gastrointestinal Bleeding in the Emergency Department

Prediction scores in gastrointestinal bleeding: a systematic review and quantitative appraisal

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