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Multicenter Study
A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding.
- Leonardo Tammaro, Andrea Buda, Maria Carla Di Paolo, Angelo Zullo, Cesare Hassan, Elisabetta Riccio, Roberto Vassallo, Luigi Caserta, Andrea Anderloni, Alessandro Natali, and T-Score Validation Study Group.
- Gastroenterology and Digestive Endoscopy, San Giovanni Addolorata Hospital, Rome, Italy. Electronic address: leonardotammaro@gmail.com.
- Dig Liver Dis. 2014 Sep 1;46(9):783-7.
BackgroundPre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding.AimsTo 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.MethodsIn 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.ResultsOverall, 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).ConclusionsThe 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.Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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