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

Abstract

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.

Comparison of Three Risk Scores to Predict Outcomes of Severe Lower Gastrointestinal Bleeding

“…In UGIB, several prognosis scores were reported (24–26) developed and validated in prospective multicenter studies. But these were only designed and validated for patients with UGIB.…”

The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review

“…To our knowledge, two systematic reviews on the predictive value of risk scores in UGIB patients have been conducted . One review by Stanley concluded that GBS has a higher diagnostic accuracy compared to the cRockall score and could be used for identifying low‐risk patients who can be managed as outpatients.…”

Initial Assessment and Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding

“…A large systematic review of scores compared the predictive performance and methodological quality of various risk stratification scores in patients with UGIB. 49 Among the preendoscopy scores, the GBS was found to be one of the highest-quality scores and its use was recommended when evaluating the need for intervention. Accumulating evidence suggests that effective and safe outpatient management can be implemented for patients admitted to the hospital with UGIB who are categorized as lowest risk using the GBS (GBS of 0) at presentation.…”

“…53 It was subsequently validated in further studies. 49 Taking into account the ability of the GBS to predict the need for treatment, a series of studies have evaluated the ability of the GBS to identify low-risk patients who may be managed as outpatients. Many of these studies found that for patients presenting with UGIB and a GBS of 0, the need for intervention was <1%.…”

“…In a systematic review of risk stratification systems for UGIB, the Rockall Score was found to be one of the highest-quality scores. 49 Consensus recommendations state that patients with a low Rockall score (r2) can be considered for prompt discharge after endoscopy. 7,9 Unfortunately, recommendations for early discharge based on low-risk endoscopic findings are still not routinely followed.…”