title: A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study.
abstract: BACKGROUND
  Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage.
  
  
  OBJECTIVE
  To develop a simple score predicting an endoscopic intervention.
  
  
  METHODS
  A prospective cohort study was conducted at a tertiary care centre. Primary outcome was the high-risk stigmata which were well-established endoscopic findings to determine the need for an endoscopic intervention. We created a simple score by multivariable logistic regression and compared with the Glasgow Blatchford Score (GBS). External validation was performed in a second cohort.
  
  
  RESULTS
  284 of consecutive 568 patients with suspected UGIB had the high-risk stigmata. Three variables were selected: "no daily use of proton pump inhibitors during one week before examination (+1 point)", "shock index (heart rate/systolic blood pressure)≥1 (+1 point)" and "urea/creatinine≥140 (blood urea nitrogen/creatinine≥30) (+1 point)". The accumulating score (range 0-3) achieved an area under the receiver-operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.70-0.78), which was superior to the GBS (AUC, 0.63; 95% CI, 0.59-0.68; p<0.001). Validation in an external cohort demonstrated superiority to the GBS (AUC, 0.78 vs. 0.59; p<0.001).
  
  
  CONCLUSIONS
  The simple score has greater accuracy than the GBS for assessing the need for an endoscopic intervention in cases of suspected UGIB. Further external validation should be performed to verify generalizability.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: masayasu-horibe@umin.ac.jp.
authors: Masayasu
authors: M
authors: Horibe
authors: Department of Clinical Trial, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors: Tetsuji
authors: T
authors: Kaneko
authors: Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Naoto
authors: N
authors: Yokogawa
authors: Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Takuya
authors: T
authors: Yokota
authors: Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Osamu
authors: O
authors: Okawa
authors: Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Yukihiro
authors: Y
authors: Nakatani
authors: Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Yuki
authors: Y
authors: Ogura
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Juntaro
authors: J
authors: Matsuzaki
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Eisuke
authors: E
authors: Iwasaki
authors: Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, Tokyo, Japan.
authors: Naoki
authors: N
authors: Hosoe
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Tatsuhiro
authors: T
authors: Masaoka
authors: Division of Gastroenterology, University of Washington, Seattle, WA, United States.
authors: John M
authors: JM
authors: Inadomi
authors: Medical Education Center, Keio University School of Medicine, Tokyo, Japan.
authors: Hidekazu
authors: H
authors: Suzuki
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Takanori
authors: T
authors: Kanai
authors: Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors: Shin
authors: S
authors: Namiki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D004724:Endoscopy / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
keywords: Endoscopic therapy; Non-variceal bleeding; Variceal bleeding