Upper Gastrointestinal Hemorrhage Score, 2014 - คะแนนทีใช้ทำนายความรุนแรงของ ภาวะเลือดออกทางเดินอาหารส่วนต้น ปี ค.ศ.2014

Abstract

              Upper gastrointestinal hemorrhage (UGIH) is one of the most common emergency clinical manifestations. The definite patient risk stratification is not widely accepted. Emergency endoscopy for every patient is not possible in many medical centers. Simple guidelines to select patients for emergency endoscopy are lacking. The aim of the present report is to develop a simple scoring system to classify upper gastrointestinal hemorrhage (UGIH) severity based on patient clinical profiles at the emergency departments. A retrospective cohort study was conducted in Kamphaeng Phet hospital Thailand. Patients were criterion-classified into 3 severity levels: mild, moderate and severe. Clinical and laboratory information were compared among the 3 groups. Significant parameters were selected as indicators of severity. Coefficients of significant multivariable parameters were transformed into item scores, which added up as individual severity scores. The scores were used to classify patients into 3 urgency levels: non-urgent, urgent and emergent groups. Score-classification and criterion-clas-sification were compared. Significant predictors in the model were age >60 years, pulse rate >100/min, systolic blood pressure <100 mmHg, he-moglobin <10 g/dL, blood urea nitrogen >35 mg/dL, presence of cirrhosis and hepatic failure. The score ranged from 0 to 27, and classifying patients into 3 urgency groups: non-urgent (score <4, n = 215, 21.22%), urgent (score 4-16, n = 677, 66.83%) and emer-gent (score >16, n = 121, 11.94%). The score correctly classified 81.32% of the patients into their original (criterion-classified) severity groups. Under-estimation (7.48%) and over-estimation (11.13%) were clinically acceptable. In conclusions,UGIH severity scoring system classified patients into 3 urgency groups: non-urgent, urgent and emergent, with clinically acceptable small number of under- and over-estimations.

Key words: upper gastrointestinal hemorrhage, severity, stratification, clinical risk, significant predictors, multivariable logistic regression