Abstract
Purpose: To develop a scoring system to stratify the need for emergent endoscopy in patients with non-variceal upper gastrointestinal bleeding using clinical parameters available in a emergency department. Methods: We conducted a prospective observational study in all patients over 18 yrs who presented to our institution with presumed non-variceal bleed. We excluded pregnant women and variceal bleeding patients. Variables collected included age, gender, medications, aspirin use, clopidogrel use, anticoagulation use, nasogastric lavage results, CBC, SMA-7, and INR. Upper endoscopy results were reported as, (1) no lesion seen (2) lesion but no therapy and (3) lesion with the need for hemostatic therapy. The primary end points were a endoscopically treated lesion versus no endoscopic treatment. Variables with impact were incorporated into a Wilcoxon rank sum test. A risk score was then developed using six variables. Results: 31 patients were enrolled in the study (mean age 66.9 years; 58% men). 16 patients were found to have actively bleeding lesions which benefited from emergent therapy. Identified impact variables included drop in hemoglobin, INR, nasogastric lavage results, age, BUN/Cr Ratio, and aspirin use. Using these variables in our proposed scoring system (Table 1), the Treatable Lesions group was found to have a statistically significant higher mean score value than the Untreatable Lesions group (3.06 vs. 1.8, p=0.0453). Seventy-five percent of the Treatable Lesions Group had a score greater than or equal to 3 while 73.3% of the Untreatable Lesions Group had a score less than 3. When a score of 1 is used as the cut-off sensitivity and specificity value, our scoring system has a sensitivity of 93.8% but a specificity of 20%. This profile of sensitivity and specificity is comparable to the published scoring systems of the Rockall and Blatchford. Our scoring system has advantages over these others because it's simple, directed towards a practical endpoint (therapy) and derived at presentation.Table: [1836] Table 1Conclusion: We have developed a useful risk stratifying scoring system that can help identify acute non-variceal bleeding patients who truly need emergent endoscopy. It is simple and can be used at patient presentation to the emergency department. External validation is needed for our study.
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