A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding

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RESEARCH PRODUCT

A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding

Andrea Anderloni M. Biagini Luigi Caserta S. Di Bella F.w. Guglielmi Maria Carla Di Paolo S. Milani S. Mazzuoli G. Scarpulla E. Cervellin Cesare Hassan Giorgio Frosini M. Ventrucci Gennaro D'amico F.v. Testai Mario Marini Raffaele Manta Leonardo Tammaro Roberto Vassallo M.c. Parodi L. Pallotta A. D’angelo D. Spotti Elisabetta Riccio S. Camilleri E. Brunelli M. De Bona Andrea Buda S. Caliendo Filippo Antonini L.m. Montalbano Clara Virgilio C. De Fanis M. Campaioli G. Costa M. Azzurro Giampiero Macarri A. Tesi Rita Conigliaro C. Peccianti Massimo Conio M. De Matthaeis G.c. Sturniolo Anna Kohn Mauro Manno Adriano Lauri R. Marin M. De Boni S. Adamo F. Ridolfi Pietro Occhipinti Angelo Zullo Alessandro Natali Antonio Craxì S. Peralta A. Ferronato P. Pozzato A. Colucci Antonio Balzano G. Occhigrossi Emanuele Sinagra F. Lamboglia M.a. Vitale

subject

Male Variceal bleeding Clinical score medicine.medical_treatment Severity of Illness Index Endoscopy Gastrointestinal HEMORRHAGE Recurrence Risk Factors Prospective Studies Aged 80 and over OUTCOMES Framingham Risk Score medicine.diagnostic_test Incidence Upper endoscopy Gastroenterology Middle Aged TIME Survival Rate Italy Female Gastrointestinal Hemorrhage Clinical risk factor medicine.medical_specialty Risk Assessment Diagnosis Differential Clinical score Endoscopy High endoscopic stigmata Upper gastrointestinal bleeding; GLASGOW-BLATCHFORD HEMORRHAGE TIME OUTCOMES medicine Humans Upper gastrointestinal bleeding Aged Hepatology business.industry Reproducibility of Results non variceal upper gastrointestinal bleeding Endoscopy medicine.disease Triage GLASGOW-BLATCHFORD Endoscopy Surgery Settore MED/18 - Chirurgia Generale Early Diagnosis High endoscopic stigmata ROC Curve Therapeutic endoscopy Upper gastrointestinal bleeding Triage business Follow-Up Studies

description

Abstract Background Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding. Aims To validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality. Methods In this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score. Results Overall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p = 0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p = 0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p = 0.3). Conclusions The T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy.

year	journal	country	edition	language
2014-01-01	Digestive and Liver Disease

https://doi.org/10.1016/j.dld.2014.05.006