Development, Validation, and Comparative Assessment of an International Scoring System to Determine Risk of Upper Gastrointestinal Bleeding

Oakland, Kathryn; Kahan, Brennan C; Guizzetti, Leonardo; Martel, Myriam; Bryant, Robert V.; Brahmania, Mayur; Singh, Siddharth; Nguyen, Nam Q.; Sey, Michael; Barkun, Alan N.; Jairath, Vipul

doi:10.1016/j.cgh.2018.09.039

Cited by 29 publications

(47 citation statements)

References 25 publications

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“…4 6 The recently described pre-endoscopic CANUKA Score shows promise in identifying lowrisk patients presenting with UGIB, however only 7% patients were encompassed by its low-risk threshold, compared with 24% using the GBS ≤1 threshold. 58 Further data on this score are awaited.…”

Section: Risk Stratificationmentioning

confidence: 99%

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Siau¹,

Hearnshaw

Stanley

et al. 2020

Frontline Gastroenterol

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Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB.Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups.Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review.A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.

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Section: Risk Stratificationmentioning

confidence: 99%

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Siau¹,

Hearnshaw

Stanley

et al. 2020

Frontline Gastroenterol

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“…They also found a marginal benefit of the CANUKA score in predicting mortality compared with the GBS (area under the receiver operating characteristic curve, 0.77 vs 0.74; P ¼ .047). Perhaps more interestingly, the CANUKA score had value in discriminating low-risk patients who Oakland et al 9 deemed would have been safe for early discharge. A presenting CANUKA score of 1 or less had a positive predictive value (PPV) of 96.3% in predicting safe discharge compared with a 95.3% PPV for safe discharge for patients with a GBS score of 1 or less.…”

mentioning

confidence: 97%

“…In this issue of Clinical Gastroenterology and Hepatology, Oakland et al 9 reported the results of a large, retrospective, international cohort study of 12,711 patients with UGIB, consisting of compiled data from 5 previously published data sets. Their goals were 2-fold.…”

mentioning

confidence: 99%

“…Second, they sought to derive and validate a new score and compare its performance with the GBS and pRS in predicting a composite poor outcome (defined as any endoscopic intervention, surgical or radiologic intervention [IR], blood transfusion, rebleeding, or mortality). Patients who did not experience the composite outcome were assigned as being safe for initial discharge, and Oakland et al 9 then investigated the performance of the clinical scores to identify these low-risk patients with UGIB.…”

mentioning

confidence: 99%

“…In a developmental data set consisting of 10,639 cases (using 3 of the cohorts), Oakland et al 9 found that the GBS was equivalent to the pRS in predicting mortality after UGIB, and was superior to the pRS across other important clinical outcomes, suggesting that there is limited clinical value in calculating a pRS (or full RS) in patients with UGIB. Oakland et al 9 then derived a new score (entitled the CANUKA score) in the developmental data set, and validated its performance in 2072 patients (using the other 2 cohorts). They found that the CANUKA score was essentially equivalent to the GBS in predicting the need for endoscopic intervention, surgery/IR, blood transfusion, and rebleeding.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Challenges to Risk Determination for Patients With Upper Gastrointestinal Bleeding

Sengupta

2019

Clinical Gastroenterology and Hepatology

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External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US

et al. 2020

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IMPORTANCE Lower gastrointestinal bleeding (LGIB), which manifests as blood in the colon or anorectum, is a common reason for hospitalization. In most patients, LGIB stops spontaneously with no in-hospital intervention. A risk score that could identify patients at low risk of experiencing adverse outcomes could help improve the triage process and allow greater numbers of patients to receive outpatient management of LGIB. OBJECTIVE To externally validate the Oakland Score, which was previously developed using a score threshold of 8 points to identify patients with LGIB who are at low risk of adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter prognostic study was conducted in 140 US hospitals in the Hospital Corporation of America network. A total of 46 179 adult patients (aged Ն16 years) admitted to the hospital with a primary diagnosis of LGIB between June 1, 2016, and October 15, 2018, were initially identified using diagnostic codes. Of those, 51 patients were excluded because they were more likely to have upper gastrointestinal bleeding, leaving a study population of 46 128 patients with LGIB. For the statistical analysis of the Oakland Score, an additional 8061 patients were excluded because they were missing data on Oakland Score components or clinical outcomes, resulting in 38 067 patients included in the analysis. The study used area under the receiver operating characteristic curves with 95% CIs for external validation of the model. Sensitivity and specificity were calculated for each score threshold (Յ8 points, Յ9 points, and Յ10 points).

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Development, Validation, and Comparative Assessment of an International Scoring System to Determine Risk of Upper Gastrointestinal Bleeding

Cited by 29 publications

References 25 publications

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Challenges to Risk Determination for Patients With Upper Gastrointestinal Bleeding

External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US

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