Leonardo Tammaro1, Andrea Buda2, Maria Carla Di Paolo3, Angelo Zullo4, Cesare Hassan5, Elisabetta Riccio6, Roberto Vassallo7, Luigi Caserta8, Andrea Anderloni9, Alessandro Natali10. 1. Gastroenterology and Digestive Endoscopy, San Giovanni Addolorata Hospital, Rome, Italy. Electronic address: leonardotammaro@gmail.com. 2. Division of Gastroenterology, University of Padua, Italy. 3. Gastroenterology and Digestive Endoscopy, San Giovanni Addolorata Hospital, Rome, Italy. 4. Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. Electronic address: angelozullo66@yahoo.it. 5. Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. 6. Gastroenterology, Cardarelli Hospital, Naples, Italy. 7. Gastroenterology and Endoscopy, Buccheri La Ferla, Fatebenefratelli Hospital, Palermo, Italy. 8. Gastroenterology and Digestive Endoscopy, IRCCS San Martino Genova, Italy. 9. Digestive Endoscopy, Istituto Clinico Humanitas, Rozzano, Milan, Italy. 10. Gastroenterology and Digestive Endoscopy, Pistoia, Italy.
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.
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.
Authors: Ashraf A Almashhrawi; Rubayat Rahman; Samuel T Jersak; Akwi W Asombang; Alisha M Hinds; Hazem T Hammad; Douglas L Nguyen; Matthew L Bechtold Journal: World J Metaanal Date: 2015-02-26