Gastroenterology Res. 2012 Dec;5(6):219-226. doi: 10.4021/gr488w. Epub 2012 Nov 20.
Upper Gastrointestinal Hemorrhage: Development of the Severity Score.
Gastroenterology research
Rangson Chaikitamnuaychok, Jayanton Patumanond
Affiliations
Affiliations
- Department of General Surgery, Kamphaeng Phet Hospital, Kamphaeng Phet, Thailand.
- Clinical Epidemiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
PMID: 27785211
PMCID: PMC5074817 DOI: 10.4021/gr488w
Abstract
BACKGROUND: Emergency endoscopy for every patient with upper gastrointestinal hemorrhage is not possible in many medical centers. Simple guidelines to select patients for emergency endoscopy are lacking. The aim of the present report is to develop a simple scoring system to classify upper gastrointestinal hemorrhage (UGIH) severity based on patient clinical profiles at the emergency departments.
METHODS: Retrospective data of patients with UGIH in a university affiliated hospital were analyzed. Patients were criterion-classified into 3 severity levels: mild, moderate and severe. Clinical and laboratory information were compared among the 3 groups. Significant parameters were selected as indicators of severity. Coefficients of significant multivariable parameters were transformed into item scores, which added up as individual severity scores. The scores were used to classify patients into 3 urgency levels: non-urgent, urgent and emergent groups. Score-classification and criterion-classification were compared.
RESULTS: Significant parameters in the model were age ≥ 60 years, pulse rate ≥ 100/min, systolic blood pressure < 100 mmHg, hemoglobin < 10 g/dL, blood urea nitrogen ≥ 35 mg/dL, presence of cirrhosis and hepatic failure. The score ranged from 0 to 27, and classifying patients into 3 urgency groups: non-urgent (score < 4, n = 215, 21.2%), urgent (score 4 - 16, n = 677, 66.9%) and emergent (score > 16, n = 121, 11.9%). The score correctly classified 81.4% of the patients into their original (criterion-classified) severity groups. Under-estimation (7.5%) and over-estimation (11.1%) were clinically acceptable.
CONCLUSIONS: Our UGIH severity scoring system classified patients into 3 urgency groups: non-urgent, urgent and emergent, with clinically acceptable small number of under- and over-estimations. Its discriminative ability and precision should be validated before adopting into clinical practice.
Keywords: Clinical prediction rules; Gastrointestinal bleeding; Gastrointestinal hemorrhage; Gastroscopy; Prognostic indicators; Scoring system
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