Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun;2(3):197-205.
doi: 10.1177/2050640614531574.

Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

Nl de Groot  1 , Mgh van Oijen  2 , K Kessels  3 , M Hemmink  3 , Blam Weusten  4 , R Timmer  3 , Wl Hazen  5 , N van Lelyveld  5 , Vermeijden Jr  5 , Wl Curvers  6 , Lc Baak  6 , R Verburg  7 , Jh Bosman  1 , Lrh de Wijkerslooth  1 , J de Rooij  8 , Ng Venneman  8 , M Pennings  9 , K van Hee  9 , Rch Scheffer  9 , Rl van Eijk  10 , R Meiland  10 , Pd Siersema  1 , Aj Bredenoord  11
Affiliations

Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

Nl de Groot et al. United European Gastroenterol J. 2014 Jun.

Abstract

Introduction: 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.

Keywords: Prediction scores; prognosis; risk; upper gastrointestinal bleeding.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of study population.
Figure 2.
Figure 2.
Association Gut Feeling and prediction scores with outcome. (a) Prediction of clinical intervention. (b) Prediction of rebleeding. (c) Prediction of mortality before endoscopy. (d) Prediction of mortality after endoscopy. Left Y-axes illustrate the percentage of patients with outcome predicted by the Gut Feeling; right Y-axes illustrate the mean prediction score for every group of the Gut Feeling.
Figure 3.
Figure 3.
ROC curves for various outcomes.
See this image and copyright information in PMC

References

    1. Toll DB, Janssen KJ, Vergouwe Y, et al. . Validation, updating and impact of clinical prediction rules: a review. J Clin Epidemiol 2008; 61: 1085–1094 - PubMed
    1. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 1997; 277: 488–494 - PubMed
    1. Lanas A, Garcia-Rodriguez LA, Polo-Tomas M, et al. . The changing face of hospitalisation due to gastrointestinal bleeding and perforation. Aliment Pharmacol Ther 2011; 33: 585–591 - PubMed
    1. Ahsberg K, Ye W, Lu Y, et al. . Hospitalisation of and mortality from bleeding peptic ulcer in Sweden: a nationwide time-trend analysis. Aliment Pharmacol Ther 2011; 33: 578–584 - PubMed
    1. Barkun AN, Bardou M, Kuipers EJ, et al. . International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101–113 - PubMed