Gastrointestinal Hemorrhage Severity Triage: Locally Derived Score May Outperform Existing Scoring Systems

BACKGROUND: Scoring tools to predict need for intervention, re-bleeding and mortality of upper gastrointestinal hemorrhage (UGIH) have been developed. It is inconclusive whether these tools are also appropriate for UGIH severity and/or urgency triage. The objective of the study was to compare the performances of the Blatchford score, the Rockall score, and the UGIH score on UGIH severity triage. METHODS: Retrospective 3-year data of UGIH patients (2009 - 2011) were collected. Patients were assigned to each of the three scoring systems based on their clinical characteristics required for the scoring systems. The score ranges of each scoring system were transformed into the same scale from 0 to 100. The score performances were compared by diagnostic indices, graphically presented with area under receiver operating curve (AuROC), discrimination curves, and statistically tested with Chi-squared tests. RESULTS: When focusing on the diagnostic indices, the local UGIH had similar sensitivity to, but better specificity than the Blatchford score in detecting mild UGIH. The sensitivity was better than and the specificity was less than the Blatchford score in detecting severe UGIH. The local UGIH score was better than the pre-endoscopic Rockall in almost all diagnostic indices. Focusing overall performances, the local UGIH score classified patients non-significantly better than the Blatchford: 89.3% vs. 87.9% for mild (P = 0.243), 87.2% vs. 85.0% for severe (P = 0.092), but significantly classified better than the pre-endoscopic Rockall score: 89.3% vs. 76.4% for mild (P < 0.001), and 87.2% vs. 81.2% for severe (P < 0.001). When exploring the discrimination curves, the Blatchford score classified more patients into the mild categories, and less into the severe categories than the local UGIH score. In contrast, the pre-endoscopic Rockall score classified less patients into the mild, but more into the severe than the local UGIH score. CONCLUSION: Triaging UGIH patients into three severity levels in order to decide or set for endoscopy should apply the scoring system specifically developed for that purpose. Adopting other scores developed for other purposes may result in under- and/or over-estimations. The local UGIH score classified patients into three severity levels to help indicate endoscopy more efficiently than the Blatchford score and the pre-endoscopic Rockall score which was developed for different purposes.