Acute Lower Gastrointestinal Bleeding in an Emergency Department and Performance of the SHA2PE Score: A Retrospective Observational Study

Abstract

Lower gastrointestinal bleeding (LGIB) is a frequent cause of emergency department (ED) consultation, leading to investigations but rarely to urgent therapeutic interventions. The SHA2PE score aims to predict the risk of hospital-based intervention, but has never been externally validated. The aim of our single-center retrospective study was to describe patients consulting our ED for LGIB and to test the validity of the SHA2PE score. We included 251 adult patients who consulted in 2017 for hematochezia of <24 h duration; 53% were male, and the median age was 54 years. The most frequent cause of LGIB was unknown (38%), followed by diverticular disease and hemorrhoids (14%); 20% had an intervention. Compared with the no-intervention group, the intervention group was 26.5 years older, had more frequent bleeding in the ED (47% vs. 8%) and more frequent hypotension (8.2% vs. 1.1%), more often received antiplatelet drugs (43% vs. 18%) and anticoagulation therapy (28% vs. 9.5%), more often had a hemoglobin level of <10.5 g/dl (49% vs. 6.2%) on admission, and had greater in-hospital mortality (8.2% vs. 0.5%) (all p < 0.05). The interventions included transfusion (65%), endoscopic hemostasis (47%), embolization (8.2%), and surgery (4%). The SHA2PE score predicted an intervention with sensitivity of 71% (95% confidence interval: 66–83%), specificity of 81% (74–86%), and positive and negative predictive values of 53% (40–65%) and 90% (84–95%), respectively. SHA2PE performance was inferior to that in the original study, with a 1 in 10 chance of erroneously discharging a patient for outpatient intervention. Larger prospective validation studies are needed before the SHA2PE score can be recommended to guide LGIB patient management in the ED.

A comparative study of scoring systems that accurately predict the prognosis of lower gastrointestinal bleeding

“…As a result of multivariate logistic regression analysis for variables related to mortality from all causes within 30 days, statistically signi cant variables were systolic blood pressure AUROC of 73%, 82%, and 0.77 (95% con dence interval: 0.70-0.84), respectively [31]. In this study, antiplatelet and anticoagulant drugs were not predictors of long-term hospitalization.…”

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

“…The AUROC of this score in identifying low-risk patients who did not require a hospital-based intervention was 0.83. However, an external validation study of 251 patients with LGIB showed that the SHA 2 PE incorrectly classified 14 patients who required a hospital-based intervention as being low-risk (45).…”