Prediction scores or gastroenterologists’ Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

Groot, NL de; Oijen, Mgh van; Kessels, Koen; Hemmink, Maarten; Weusten, Blam; Timmer, Robin; Hazen, Wouter; Lelyveld, Niels van; Vermeijden, J.W.; Curvers, WL; Baak, LC; Verburg, Robert J.; Bosman, J. H.; Wijkerslooth, Lrh de; Rooij, J de; Venneman, NG; Pennings, Marieke; Hee, Koen van; Scheffer, Rch; Eijk, RL van; Meiland, Ruby; Siersema, PD; Bredenoord, Albert J.

doi:10.1177/2050640614531574

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…As regards age, this study showed that, the mean age of studied patients was 56.92 ± 11.54 years. This is similar to results of De Groot et al, who evaluated value of prediction scores in patients with suspected upper gastrointestinal bleeding, and found that the mean age of the studied patients was 65 (range 18 -99) [11]. and that 63% of their studied patients were males too.…”

Section: Discussionsupporting

confidence: 90%

“…Twenty percent of patients in this study were shocked during presentation and this finding is similar to a study conducted by Gado et al [16] who stated that (18%) were shocked during presentation. Blood transfusion was required to (58%) of patients in the current study and this also similar to the study of De Groot et al [11] who stated that blood transfusion was required for (58%) of patients and supported with Morsy et al [13] who stated in their study that blood transfusion was required for (61%) of patients.…”

Section: Discussionsupporting

confidence: 89%

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Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding

Reda¹,

Montasser²,

Saleh³

et al. 2015

OJGas

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Background: One of the major challenges in managing acute upper gastrointestinal bleeding involves the identification of patients who are at high risk of rebleeding and death; conversely, the identification of patients who are suitable for early discharge and outpatient endoscopy is also important for effective resource. The use of Rockall system has been shown to represent accurate and valid predictor of rebleeding and death. The aim of this prospective study was to evaluate validity of Rockall score for prediction of rebleeding and mortality in Egyptian patients with upper gastrointestinal bleeding. Patients and Methods: 50 patients presented with upper GI bleeding were subjected to detailed clinical, laboratory, sonographic and endoscopic examination together with Rockall score calculation. Results: According to the findings of upper GI endoscopy patients were further subdivided into two subgroups as follows: Group 1 (n = 32): Patients with portal hypertension manifested by variceal bleeding and/or portal hypertensive gastropathy; and Group 2 (n = 18): other causes of acute upper gastrointestinal bleeding (peptic ulcer disease, Mallory Weiss syndrome…). Clinical condition of the patients was assessed after 48 hours and mortality was recorded. Rockall score was the highest in mortality group, and higher in rebleeding group than stable group (P < 0.01). Rockall score was higher in Child C than Child B and Child A among hepatic patients (P < 0.01). The cutoff value of Rockall score = 3.5 was the best for prediction of rebleeding with sensitivity 100%, specificity 53%, while the cutoff value = 6.5 was the best for prediction of mortality with sensitivity 100% and 93.5% specificity. Conclusion: Rockall score is clinically useful in prediction of rebleeding and mortality in patients with upper gastrointestinal * Corresponding author. M. A. Reda et al. 67 bleeding. It can accurately differentiate between patients with stable condition that could be discharged from hospital and those who require hospitalization and this could help to minimize hospital stay and cost.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding

Reda¹,

Montasser²,

Saleh³

et al. 2015

OJGas

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“…Despite the fact that use of risk scores in management of UGIB is recommended in several studies and guidelines [2,13,14], its role in actual clinical decisions and hospital guidelines is still unclear [17]. Although, some studies proved that risk scores are a stronger predictor than clinical decision, others believe the opposite [2,18,19]. This controversy may originate from variations in hospital characteristic; however, in our hospital, as patients are initially assessed by junior doctors, using risk scores seems to be preferred approach.…”

Section: Discussionmentioning

confidence: 99%

“…Following the introduction of these systems, numerous studies have been conducted to validate them [2] and the discrepancy in results led to the idea that variation in geographical region and health care system affects the accuracy of risk scores [17][18][19]. Although, many guidelines suggest that low risk patients can be managed as outpatient, In our hospital all patients with UGIB undergo endoscopy and the timing is mostly within the first 24 hours of admission [14,20].…”

Section: Introductionmentioning

confidence: 99%

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Shafaghi¹,

Gharibpoor

Mahdipour

et al. 2019

Romanian Journal of Internal Medicine

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Introduction. Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores. Methods. This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn’t undergo endoscopy or had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing albumin threshold from <3.5 to <3.0 in AIMS65 and addition of albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated. Result. Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was erosive disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of ≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively. Conclusion. Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS ≤ 2 seemed to be advisable choice.

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“…In a recent multicentre study, although clinical knowledge of the endoscopists (described as "gut feeling") was an independent predictor for an adverse outcome, it had a lower sensitivity and a worst predictive power compared to prediction scores [77] . The reasons for not using clinical scores may be that they are difficult to calculate and time consuming and do not add much information to the physician's knowledge.…”

Section: Therapeutic Decisions -Why or Why Not Should We Use A Risk Smentioning

confidence: 99%

Upper gastrointestinal bleeding risk scores: Who, when and why?

Monteiro

Gonçalves

Magalhães

et al. 2016

WJGP

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Prediction scores or gastroenterologists’ Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

Cited by 19 publications

References 23 publications

Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding

Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding

Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Upper gastrointestinal bleeding risk scores: Who, when and why?

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