Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleedin

The Article: Development and Validation of a Risk Scoring System for Severe

Acute Lower Gastrointestinal Bleeding

Clinical Gastroenterology and Hepatology 2016

The Idea: Develop a scoring system to help predict patient outcomes and severity of lower GI bleeds (LGIB)

The Study:

1. Derivation study:

-Retrospective analysis of 439 emergency department patients in single center in Japan

– Inclusion criteria: confirmed bleed on colonoscopy, bleeding developed outside the hospital

-Exclusion criteria: patients with upper GI bleeds, chronic LGIB, inpatient development of bleeding

1. Validation study:

-Prospective analysis of 424 patients at same center as derivation study

-Inclusion criteria: overt GIB in emergency department, confirmed by colonoscopy as inpatient

-Exclusion criteria: inpatient development of bleed, no confirmatory studies, UGIB

Primary Outcomes: continuous LGIB in the first 24 hours, 2U PRBCs, Hct drop of  >20%

Secondary Outcomes: blood transfusion requirement, need for intervention, length of stay

The Findings:

-Derivation study developed risk scoring system: nonsteroidal anti-inflammatory drugs use, no diarrhea, no abdominal tenderness, blood pressure of 100 mm Hg or lower, antiplatelet drugs use, albumin level less than 3.0 g/dL, disease scores of 2 or higher, and syncope (NOBLADS)

-All factors were independent correlates of severe LGIB

-Severe LGIB developed in 75.7% of patients with scores of 5 or higher compared with 2% of patients without any of the factors correlated with severe LGIB (P < .001)

-In the validation study severe LGIB developed in 35% of patients

-NOBLADS score predicted the severity of LGIB with an AUC value of 0.76

-Higher NOBLADS scores were associated with a requirement for blood transfusion, longer hospital stay, and intervention (P < .05 for trend).

The Limitations:

-Derivation/validation studies performed at single center

-May have missed small LGIB hemorrhage given small patient size

The Takeaway:

Predicting severity of LGIB and dispositioning patients appropriately can be difficult, this study found patient characteristics that seem to correlate with poor patient outcomes and more severe LGIB.

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