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. 2025 Jan 3:2025:5657404.
doi: 10.1155/grp/5657404. eCollection 2025.

External Validation of SHA2PE Score: A Score to Predict Low-Risk Lower Gastrointestinal Bleeding in the Emergency Department

Akram I Ahmad  1 , Ahmed El Sabagh  2 , Jennie Zhang  3 , Claire Caplan  4 , Ahmad Al-Dwairy  2 , Tarek Bakain  2 , Faith Buchanan  2 , Lea Fisher  2 , Andrew Wilbur  4 , Samantha Marshall  4 , Garrett Buechner  4 , Malaak Hamzeh  4 , Rachna Dhanjal  4 , Alexander Boos  4 , Lynette Sequeira  4
Affiliations

External Validation of SHA2PE Score: A Score to Predict Low-Risk Lower Gastrointestinal Bleeding in the Emergency Department

Akram I Ahmad et al. Gastroenterol Res Pract. .

Abstract

Introduction: Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. Aim: The purpose of this study was to validate a scoring system designed to identify cases of low-risk LGIB, allowing for safe discharge from the ED. Methods: A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB. The SHA2PE score incorporates factors such as systolic blood pressure, hemoglobin levels, use of antiplatelet or anticoagulant medications, pulse rate, and episodes of bright blood per rectum. Results: Out of 1112 patients presenting with LGIB to the ED, 55 were hospitalized, 20 required blood transfusions, 15 underwent colonoscopies, one underwent interventional radiology procedures, and two patients died. Employing a SHA2PE score with a cutoff value of 1 yielded a specificity of 78.5% (95% CI (confidence interval) [75.8-81.0]), sensitivity of 76.8% (95% CI [63.6-87.0]), positive predictive value (PPV) of 17.0% (95% CI [12.6-22.2]), and negative predictive value (NPV) of 98.3% (95% CI [97.2-99.1]) for predicting the need for hospitalization and intrahospital intervention. When considering return visits to the ED within 7 days with the same presentation, the score demonstrated a specificity of 78.8% (95% CI [76.0-81.3]), sensitivity of 68.6% (95% CI [56.4-79.1]), PPV of 19% (95% CI [14.3-24.4]), and NPV of 97.2% (95% CI [95.8-98.2]). Conclusions: The SHA2PE score demonstrates potential in predicting cases of low-risk LGIB, offering a high NPV for hospitalization, the need for intrahospital intervention, and return visits to the ED. However, these findings should be interpreted cautiously given the low prevalence of interventions and limitations in the study's population and design.

Keywords: hospitalization; low risk; lower gastrointestinal bleeding; score.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study population and groups. BBPR: bright blood per rectum, UGIB: upper gastrointestinal bleed.
Figure 2
Figure 2
ROC curve based on the SHA2PE score.
See this image and copyright information in PMC

References

    1. Laine L., Yang H., Chang S.-C., Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Official Journal of the American College of Gastroenterology| ACG . 2012;107(8):1190–1195. doi: 10.1038/ajg.2012.168. - DOI - PubMed
    1. Charilaou P., Devani K., Enjamuri D., Radadiya D., Reddy C. M., Young M. Epidemiology of Lower GI Bleed in the United States - An Update From the National Inpatient Survey 2005-2014. Official Journal of the American College of Gastroenterology|ACG . 2018;113:p. S319. doi: 10.14309/00000434-201810001-00559. - DOI
    1. Javaid T., Siddiqui N., Hasan S., et al. The in-hospital mortality rate in gastrointestinal hemorrhage with shock: a nationwide Analysis. Official Journal of the American College of Gastroenterology| ACG . 2016;111:p. S420. doi: 10.14309/00000434-201610001-00966. - DOI
    1. Serur A., Rhee R., Ramjist J. Current nonoperative therapeutic interventions for lower gastrointestinal hemorrhage. Clinics in Colon and Rectal Surgery . 2020;33(1):22–27. doi: 10.1055/s-0039-1695033. - DOI - PMC - PubMed
    1. Strate L. L., Orav E. J., Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Archives of Internal Medicine . 2003;163(7):838–843. doi: 10.1001/archinte.163.7.838. - DOI - PubMed

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