Abstract
Lower gastrointestinal bleeding (LGIB) is a frequent cause of emergency department (ED) consultation, leading to investigations but rarely to urgent therapeutic interventions. The SHA2PE score aims to predict the risk of hospital-based intervention, but has never been externally validated. The aim of our single-center retrospective study was to describe patients consulting our ED for LGIB and to test the validity of the SHA2PE score. We included 251 adult patients who consulted in 2017 for hematochezia of <24 h duration; 53% were male, and the median age was 54 years. The most frequent cause of LGIB was unknown (38%), followed by diverticular disease and hemorrhoids (14%); 20% had an intervention. Compared with the no-intervention group, the intervention group was 26.5 years older, had more frequent bleeding in the ED (47% vs. 8%) and more frequent hypotension (8.2% vs. 1.1%), more often received antiplatelet drugs (43% vs. 18%) and anticoagulation therapy (28% vs. 9.5%), more often had a hemoglobin level of <10.5 g/dl (49% vs. 6.2%) on admission, and had greater in-hospital mortality (8.2% vs. 0.5%) (all p < 0.05). The interventions included transfusion (65%), endoscopic hemostasis (47%), embolization (8.2%), and surgery (4%). The SHA2PE score predicted an intervention with sensitivity of 71% (95% confidence interval: 66–83%), specificity of 81% (74–86%), and positive and negative predictive values of 53% (40–65%) and 90% (84–95%), respectively. SHA2PE performance was inferior to that in the original study, with a 1 in 10 chance of erroneously discharging a patient for outpatient intervention. Larger prospective validation studies are needed before the SHA2PE score can be recommended to guide LGIB patient management in the ED.
Highlights
Lower gastrointestinal bleeding (LGIB), defined as bleeding originating distal to the ligament of Treitz, accounts for 30–40% of all gastrointestinal hemorrhages
Most LGIB scores have focused on identifying patients at risk of major rebleeding [11–13], not on identifying those who could be managed as outpatients [11], a gap that the SHA2 PE score was developed to fill (Appendix A) [9]
Our study shows that one in two patients admitted for hematochezia benefited from investigations, that one in five benefited from an intervention and that their in-hospital mortality was very low
Summary
Lower gastrointestinal bleeding (LGIB), defined as bleeding originating distal to the ligament of Treitz, accounts for 30–40% of all gastrointestinal hemorrhages. Most LGIB scores have focused on identifying patients at risk of major rebleeding [11–13], not on identifying those who could be managed as outpatients [11], a gap that the SHA2 PE score was developed to fill (Appendix A) [9]. This acronym stands for Systolic pressure, Hemoglobin, Anticoagulant or Antiplatelet therapy, Pulse and Emergency room bleeding. A score of ≤1 point indicates a low probability of hospital intervention, allowing for outpatient treatment. This score has not yet undergone external validation
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