title: Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding.
abstract: BACKGROUND
  Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added value of prediction scores to gastroenterologists' Gut Feeling in patients with a suspected upper GI bleeding.
  
  
  METHODS
  WE PROSPECTIVELY EVALUATED GUT FEELING OF SENIOR GASTROENTEROLOGISTS AND ASKED THEM TO ESTIMATE: (1) the risk that a clinical intervention is needed; (2) the risk of rebleeding; and (3) the risk of mortality in patients presenting with suspected upper GI bleeding, subdivided into low, medium, or high risk. The predictive value of the gastroenterologists' Gut Feeling was compared to the Blatchford and Rockall scores for various outcomes.
  
  
  RESULTS
  We included 974 patients, of which 667 patients (68.8%) underwent a clinical intervention. During the 30-day follow up, 140 patients (14.4%) developed recurrent bleeding and 44 patients (4.5%) died. Gut Feeling was independently associated with all studied outcomes, except for the predicted mortality after endoscopy. Predictive power, based on the AUC of the Blatchford and Rockall prediction scores, was higher than the Gut Feeling of the gastroenterologists. However, combining both the Blatchford and Rockall scores and the Gut Feeling yielded the highest predictive power for the need of an intervention (AUC 0.88), rebleeding (AUC 0.73), and mortality (AUC 0.71 predicted before and 0.77 predicted after endoscopy, respectively).
  
  
  CONCLUSIONS
  Gut Feeling is an independent predictor for the need of a clinical intervention, rebleeding, and mortality in patients presenting with upper GI bleeding; however, the Blatchford and Rockall scores are stronger predictors for these outcomes. Combining Gut Feeling with the Blatchford and Rockall scores resulted in the most optimal prediction.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Nl
authors.initials: N
authors.lastname: de Groot
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands ; University of California Los Angeles/Veterans Affairs Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA ; Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Mgh
authors.initials: M
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Kessels
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hemmink
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands ; Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: Blam
authors.initials: B
authors.lastname: Weusten
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Timmer
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Wl
authors.initials: W
authors.lastname: Hazen
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: van Lelyveld
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.lastname: Vermeijden
authors.affiliation: Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Wl
authors.initials: W
authors.lastname: Curvers
authors.affiliation: Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Lc
authors.initials: L
authors.lastname: Baak
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Center Haaglanden, Den Haag, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Verburg
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Jh
authors.initials: J
authors.lastname: Bosman
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Lrh
authors.initials: L
authors.lastname: de Wijkerslooth
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Rooij
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Ng
authors.initials: N
authors.lastname: Venneman
authors.affiliation: Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Pennings
authors.affiliation: Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: van Hee
authors.affiliation: Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
authors.forename: Rch
authors.initials: R
authors.lastname: Scheffer
authors.affiliation: Department of Gastroenterology and Hepatology, The Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Rl
authors.initials: R
authors.lastname: van Eijk
authors.affiliation: Department of Gastroenterology and Hepatology, The Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Meiland
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Pd
authors.initials: P
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands ; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands ; Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: Aj
authors.initials: A
authors.lastname: Bredenoord
keywords: Prediction scores; prognosis; risk; upper gastrointestinal bleeding