Quitadamo Paolo, Anselmi Federica, Mantegazza Cecilia, Tambucci Renato, Campanozzi Angelo, Malamisura Monica, Raucci Umberto, Tipo Vincenzo, Dolce Pasquale, Saccomani Marco Deganello, Chiaro Andrea, Mancini Valentina, Felici Enrico, Orizio Paolo, Parma Barbara, Salvatore Silvia, Borrelli Osvaldo
From the Department of Pediatrics, Santobono-Pausilipon Children's Hospital.
Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples.
Pediatr Emerg Care. 2022 May 1;38(5):e1245-e1250. doi: 10.1097/PEC.0000000000002579. Epub 2021 Dec 23.
Infantile acute upper gastrointestinal bleeding involves a decision for therapeutic intervention that most pediatricians first coming into contact with the patient are, not unreasonably, unable to objectively provide. Therefore, some objective tools of individual risk assessment would seem to be crucial. The principal aim of the present study was to investigate the anamnestic and clinical parameters of infants with hematemesis, together with laboratory and instrumental findings, to create a scoring system that may help identify those infants requiring an appropriate and timely application of upper gastrointestinal (GI) endoscopy.
Clinical data of infants admitted for hematemesis to the participating centers over the study period were systematically collected. According to the outcome dealing with rebleeding, need for blood transfusion, mortality, finding of GI bleeding lesions, or need for surgical intervention, patients were blindly divided into a group with major clinical severity and a group with minor clinical severity. Univariate and multivariate logistic regressions were conducted to investigate significant prognostic factors for clinical severity.
According to our findings, we drafted a practical diagnostic algorithm and a clinical score able to predict the need for timely upper GI endoscopy (BLOVO infant score). Our clinical scoring system was created by incorporating anamnestic factors, clinical parameters, and laboratory findings that emerged as predictors of a worst outcome.
We provided the first objective tool of individual risk assessment for infants with hematemesis, which could be very useful for pediatricians first coming into contact with the patient in the emergency department.
小儿急性上消化道出血涉及治疗干预的决策，大多数首次接触此类患儿的儿科医生无法客观地做出决策，这并非不合理。因此，一些客观的个体风险评估工具似乎至关重要。本研究的主要目的是调查呕血婴儿的既往史和临床参数，以及实验室和器械检查结果，以创建一个评分系统，帮助识别那些需要及时进行上消化道（GI）内镜检查的婴儿。
系统收集研究期间参与中心收治的呕血婴儿的临床资料。根据再出血、输血需求、死亡率、胃肠道出血病变的发现或手术干预需求等结果，将患者随机分为临床严重程度较高组和临床严重程度较低组。进行单因素和多因素逻辑回归分析，以研究临床严重程度的显著预后因素。
根据研究结果，我们制定了一个实用的诊断算法和一个能够预测及时进行上消化道内镜检查需求的临床评分（BLOVO婴儿评分）。我们的临床评分系统是通过纳入既往史因素、临床参数和实验室检查结果而创建的，这些因素被证明是不良预后的预测指标。
我们为呕血婴儿提供了首个客观的个体风险评估工具，这对急诊科首次接触此类患儿的儿科医生可能非常有用。
