title: A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding.
abstract: BACKGROUND
  Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding.
  
  
  OBJECTIVE
  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: Gastroenterology and Digestive Endoscopy, San Giovanni Addolorata Hospital, Rome, Italy. Electronic address: leonardotammaro@gmail.com.
authors: Leonardo
authors: L
authors: Tammaro
authors: Division of Gastroenterology, University of Padua, Italy.
authors: Andrea
authors: A
authors: Buda
authors: Gastroenterology and Digestive Endoscopy, San Giovanni Addolorata Hospital, Rome, Italy.
authors: Maria Carla
authors: MC
authors: Di Paolo
authors: Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. Electronic address: angelozullo66@yahoo.it.
authors: Angelo
authors: A
authors: Zullo
authors: Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
authors: Cesare
authors: C
authors: Hassan
authors: Gastroenterology, Cardarelli Hospital, Naples, Italy.
authors: Elisabetta
authors: E
authors: Riccio
authors: Gastroenterology and Endoscopy, Buccheri La Ferla, Fatebenefratelli Hospital, Palermo, Italy.
authors: Roberto
authors: R
authors: Vassallo
authors: Gastroenterology and Digestive Endoscopy, IRCCS San Martino Genova, Italy.
authors: Luigi
authors: L
authors: Caserta
authors: Digestive Endoscopy, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
authors: Andrea
authors: A
authors: Anderloni
authors: Gastroenterology and Digestive Endoscopy, Pistoia, Italy.
authors: Alessandro
authors: A
authors: Natali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014218:Triage / Q000379:methods*
keywords: Clinical score; Endoscopy; High endoscopic stigmata; Upper gastrointestinal bleeding