title: A risk score system for identification of patients with upper-GI bleeding suitable for outpatient management.
abstract: BACKGROUND
  The aim of this study was to develop a risk score system for identification of patients with upper-GI hemorrhage who are suitable for outpatient management.
  
  
  METHODS
  From a prospective cohort of 983 consecutive patients with upper-GI hemorrhage not associated with portal hypertension, 581 cases that did not meet pre-established criteria for admission were selected, and a logistic regression analysis was performed to identify factors associated with two adverse outcomes: recurrent bleeding and/or the need for emergency surgery. The risk score system was developed by using the beta coefficients of the logistic model, and its performance was evaluated. The results of this model were combined with pre-established criteria for admission to build a simplified scoring system for identification of patients who can be managed safely on an outpatient basis.
  
  
  RESULTS
  Chronic alcoholism, active malignancy, prior upper digestive tract surgery, wasting syndrome, hemodynamic compromise, duodenal ulcer as the cause of upper-GI hemorrhage, and hemorrhage of unknown cause were independently associated with a greater risk of unfavorable outcomes in the group that did not meet pre-established criteria for admission. The logistic model showed a high capacity for discrimination (C statistic: 0.87) and good calibration (p value for Hosmer-Lemeshow goodness-of-fit test, 0.62), with a sensitivity of 100% and specificity of 64%. The simplified score had a sensitivity of 100% and specificity of 29% for adverse outcomes, and sensitivity of 78% and specificity of 38% for mortality.
  
  
  CONCLUSIONS
  The score system developed in this study may be helpful in deciding between hospitalization and outpatient management for patients with upper-GI hemorrhage, but it remains to be validated in patient groups other than those used for its development.
authors.affiliation: Servicio de Gastroenterología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Almela
authors.forename: Adolfo
authors.initials: A
authors.lastname: Benages
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
authors.forename: Ramón
authors.initials: R
authors.lastname: Añón
authors.forename: Miguel Minguez
authors.initials: MM
authors.lastname: Pérez
authors.forename: Andrés
authors.initials: A
authors.lastname: Peña
authors.forename: Isabel
authors.initials: I
authors.lastname: Pascual
authors.forename: Francisco
authors.initials: F
authors.lastname: Mora
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome