Endoscopist's Judgment Is as Useful as Risk Scores for Predicting Outcome in Peptic Ulcer Bleeding: A Multicenter Study.

Enric Brullet,Pilar Garcia-Iglesias,David Suarez,Xavier Calvet,Raquel Ballester,Félix Junquera,Montserrat Planella,Michel Papo,Eva Martinez-Bauer,Albert Pardo,Silvia Montoliu,Rafel Campo

doi:10.3390/jcm9020408

Abstract

Background: Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Objective: Compare the diagnostic accuracy of the endoscopist’s judgment against different risk-scoring systems (Rockall, Glasgow–Blatchford, Baylor and the Cedars–Sinai scores) for predicting outcomes in peptic ulcer bleeding (PUB). Methods: Between February 2006 and April 2010 we prospectively recruited 401 patients with peptic ulcer bleeding; 225 received endoscopic treatment. The endoscopist recorded his/her subjective assessment (“endoscopist judgment”) of the risk of rebleeding and death immediately after endoscopy for each patient. Independent evaluators calculated the different scores. Area under the receiver-operating-characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values were calculated for rebleeding and mortality. Results: The areas under ROC curve of the endoscopist’s clinical judgment for rebleeding (0.67–0.75) and mortality (0.84–0.9) were similar or even superior to the different risk scores in both the whole group and in patients receiving endoscopic therapy. Conclusions: The accuracy of the currently available risk scores for predicting rebleeding and mortality in PUB patients was moderate and not superior to the endoscopist’s judgment. More precise prognostic scales are needed.

Highlights

Non-variceal upper gastrointestinal bleeding (NVUGB) is a common reason for hospital admission and a major cause of mortality, morbidity and health-care expenditure [1,2]
The present study shows that scoring systems are not superior to the endoscopist’s clinical judgment for predicting either rebleeding or mortality in peptic ulcer bleeding (PUB)
Both endoscopist’s clinical judgment and scoring systems have only moderate reliability for predicting outcomes in PUB. This finding is striking, as it challenges the recent international consensus recommendations that risk scores should be used [6,15,16]. Both clinical judgment and risk scores are least reliable in the setting in which they might be expected to be most useful: that is, in predicting rebleeding after endoscopic therapy

Summary

Introduction

Non-variceal upper gastrointestinal bleeding (NVUGB) is a common reason for hospital admission and a major cause of mortality, morbidity and health-care expenditure [1,2]. Guidelines recommend using prognostic scales for risk stratification in patients with non-variceal upper gastrointestinal bleeding. It remains unclear whether risk scores offer greater accuracy than clinical evaluation. Objective: Compare the diagnostic accuracy of the endoscopist’s judgment against different risk-scoring systems (Rockall, Glasgow–Blatchford, Baylor and the Cedars–Sinai scores) for predicting outcomes in peptic ulcer bleeding (PUB). Results: The areas under ROC curve of the endoscopist’s clinical judgment for rebleeding (0.67–0.75) and mortality (0.84–0.9) were similar or even superior to the different risk scores in both the whole group and in patients receiving endoscopic therapy. Conclusions: The accuracy of the currently available risk scores for predicting rebleeding and mortality in PUB patients was moderate and not superior to the endoscopist’s judgment.

Objectives

Methods

Results

Conclusion