Ministry of Health Holdings, 110 Sengkang E Way, Singapore, 544886, Singapore.
Ministry of Health Holdings, Singapore, Singapore.
BMC Gastroenterol. 2023 Oct 9;23(1):349. doi: 10.1186/s12876-023-02950-w.
Bleeding from the lower gastrointestinal tract (LGITB) is a common clinical presentation. Recent guidelines have recommended for incorporation of clinical risk assessment tools in the management for LGITB. We derived and validated a novel clinical scoring system to predict safe discharge after LGITB admission, and compared it to other published scoring systems in current literature.
A retrospective cohort of 798 patients with LGITB from August 2018 to March 2021 was included in the derivation cohort. Multivariate binary logistic regression was performed to identify significant clinical variables predictive of safe discharge. A clinical scoring system was developed based on the results, and validated on a prospective cohort of 312 consecutive patients with LGITB from April 2021 to March 2022. The performance of the novel scoring system was compared to other LGITB clinical risk assessment scores via area under the receiver operating characteristics curve (AUROC) analysis.
Variables predictive of safe discharge included the following; absence of previous LGITB admission, absence of ischemic heart disease, absence of blood on digital rectal examination, absence of dizziness or syncope at presentation and the systolic blood pressure and haemoglobin levels at presentation. The novel score had an AUROC of 0.907. A cut-off point of 4 provided a sensitivity of 41.9%, specificity of 97.5%, positive predictive value of 96.4% and negative predictive value of 51.5% for prediction of safe discharge. The score performs comparably to the Oakland score.
The novel LGITB clinical risk score has good predictive performance for safe discharge in patients admitted for LGITB.
下消化道出血（LGITB）是一种常见的临床症状。最近的指南建议在 LGITB 的治疗中纳入临床风险评估工具。我们开发并验证了一种新的临床评分系统，以预测 LGITB 入院后安全出院的可能性，并将其与当前文献中其他已发表的评分系统进行比较。
纳入了 2018 年 8 月至 2021 年 3 月期间因 LGITB 入院的 798 例患者的回顾性队列。使用多变量二项逻辑回归来确定预测安全出院的有意义的临床变量。根据结果开发了一种临床评分系统，并在 2021 年 4 月至 2022 年 3 月期间对 312 例连续因 LGITB 入院的患者进行了前瞻性验证。通过接受者操作特征曲线（AUROC）分析比较了新型评分系统与其他 LGITB 临床风险评估评分的性能。
预测安全出院的变量包括：既往无 LGITB 入院史、无缺血性心脏病、直肠指检无血便、就诊时无头晕或晕厥、就诊时的收缩压和血红蛋白水平。新型评分的 AUROC 为 0.907。当截断值为 4 时，预测安全出院的敏感性为 41.9%，特异性为 97.5%，阳性预测值为 96.4%，阴性预测值为 51.5%。该评分与奥克兰评分性能相当。
新型 LGITB 临床风险评分对因 LGITB 入院的患者安全出院具有良好的预测性能。
