The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review

Rosa Ramaekers; Muhammad Mukarram; Christine A M Smith; Venkatesh Thiruganasambandamoorthy

doi:10.1111/acem.13101

The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review

Acad Emerg Med. 2016 Nov;23(11):1218-1227. doi: 10.1111/acem.13101. Epub 2016 Nov 1.

Authors

Rosa Ramaekers^{1

2

3}, Muhammad Mukarram¹, Christine A M Smith², Venkatesh Thiruganasambandamoorthy^{1

2

3}

Affiliations

¹ Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
² School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

PMID: 27640399
DOI: 10.1111/acem.13101

Abstract

Objectives: Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision-making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30-day serious adverse events.

Methods: We searched MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating preendoscopic risk scores and excluded reviews, case reports, and animal studies. The composite outcome included 30-day mortality, recurrent bleeding, and need for intervention. In two phases (screening and full review), two reviewers independently screened articles for inclusion and extracted patient-level data. The consensus data were used for analysis. We reported sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios with 95% confidence intervals.

Results: We identified 3,173 articles, of which 16 were included: three studied Glasgow Blatchford score (GBS); one studied clinical Rockall score (cRockall); two studied AIMS65; six compared GBS and cRockall; three compared GBS, a modification of the GBS, and cRockall; and one compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS were 0.98 and 0.16, respectively; for the cRockall they were 0.93 and 0.24, respectively; and for the AIMS65 they were 0.79 and 0.61, respectively. The GBS with a cutoff point of 0 had a sensitivity of 0.99 and a specificity of 0.08.

Conclusion: The GBS with a cutoff point of 0 was superior over other cutoff points and risk scores for identifying low-risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and, hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB.

Publication types

Review
Systematic Review

MeSH terms

Decision Making
Emergency Service, Hospital*
Female
Gastrointestinal Hemorrhage / diagnosis*
Humans
Male
Outcome Assessment, Health Care*
Predictive Value of Tests
Prospective Studies
Retrospective Studies
Risk Assessment / methods*
Sensitivity and Specificity