Tang Yuedong, Shen Jie, Zhang Feng, Zhou Xiaoyong, Tang Zhongyan, You Tingting
Department of Emergency and Critical Care Medicine, Jin Shan Hospital, Fudan University, Shanghai, China.
Department of Emergency and Critical Care Medicine, Jin Shan Hospital, Fudan University, Shanghai, China.
Am J Emerg Med. 2018 Jan;36(1):27-32. doi: 10.1016/j.ajem.2017.06.053. Epub 2017 Jun 27.
Acute upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department (ED). We aimed to compare the performance of the AIMS65, Glasgow-Blatchford (Blatchford), preendoscopic Rockall (pre-Rockall), and preendoscopic Baylor bleeding (pre-Baylor) scores in predicting 30-day mortality in patients with acute UGIB in the ED setting.
Consecutive patients with acute UGIB who were admitted to the ED ward during 2012-2016 were retrospectively recruited. Data were retrieved from the admission list of the ED using international classification of disease codes via computer registration. The predictive accuracy of these four scores was compared using the area under the receiver operating characteristic curve (AUC) method.
Among the 395 patients included during the study period, the total 30-day mortality rate was 10.4% (41/395). The AIMS65 and Glasgow-Blatchford scores performed better with an AUC of 0.907 (95% confidence interval (CI), 0.852-0.963; P<0.001) and 0.870 (95% confidence interval, 0.833-0.902; P<0.001) compared with other scoring systems (preendoscopic Rockall score: AUC, 0.709; 95% CI, 0.635-0.784; P<0.001; preendoscopic Baylor score: AUC, 0.523; 95% CI, 0.472-0.573; P>0.05).
In patients with acute UGIB in the ED, the AIMS65 and Glasgow-Blatchford scores are clinically more useful for predicting 30-day mortality than the preendoscopic Rockall and preendoscopic Baylor scores. The AIMS65 score might be more ideal for risk stratification in the ED setting.
急性上消化道出血（UGIB）是一种可能危及生命的疾病，需要在急诊科（ED）进行快速评估。我们旨在比较AIMS65、格拉斯哥-布拉奇福德（Blatchford）、内镜检查前罗卡尔（pre-Rockall）和内镜检查前贝勒出血（pre-Baylor）评分在预测急诊科急性UGIB患者30天死亡率方面的表现。
回顾性纳入2012年至2016年期间入住急诊科病房的连续性急性UGIB患者。通过计算机登记使用国际疾病分类代码从急诊科入院名单中检索数据。使用受试者操作特征曲线（AUC）下面积法比较这四种评分的预测准确性。
在研究期间纳入的395例患者中，30天总死亡率为10.4%（41/395）。与其他评分系统相比，AIMS65和格拉斯哥-布拉奇福德评分表现更好，AUC分别为0.907（95%置信区间（CI），0.852-0.963；P<0.001）和0.870（95%置信区间，0.833-0.902；P<0.001）（内镜检查前罗卡尔评分：AUC，0.709；95%CI，0.635-0.784；P<0.001；内镜检查前贝勒评分：AUC，0.523；95%CI，0.472-0.573；P>0.05）。
在急诊科急性UGIB患者中，AIMS65和格拉斯哥-布拉奇福德评分在预测30天死亡率方面比内镜检查前罗卡尔和内镜检查前贝勒评分在临床上更有用。AIMS65评分可能更适合急诊科环境中的风险分层。
