Bordley D R, Mushlin A I, Dolan J G, Richardson W S, Barry M, Polio J, Griner P F
JAMA. 1985 Jun 14;253(22):3282-5.
Early identification of patients at low risk for poor outcome after acute upper gastrointestinal hemorrhage would allow reduction of diagnostic and therapeutic interventions. We identified six early predictors of good outcome: age less than 75 years, no unstable comorbid illness, no ascites found on physical examination, normal prothrombin time, and, within an hour after presentation, systolic blood pressure of 100 mm Hg or greater and nasogastric aspirate free of fresh blood. Presence of all six predictors defined the low-risk population. Among 162 patients in the development and retrospective validation phases of our study, all 74 low-risk patients had good outcomes. A prospective validation study of 111 patients further established the accuracy of our predictive method; only two of 52 low-risk patients had poor outcomes. Application of our method should allow more selective management of patients with acute upper gastrointestinal hemorrhage.
早期识别急性上消化道出血后预后不良风险较低的患者，将有助于减少诊断和治疗干预措施。我们确定了六个预后良好的早期预测指标：年龄小于75岁、无不稳定的合并症、体格检查未发现腹水、凝血酶原时间正常，以及就诊后一小时内收缩压≥100mmHg且胃管抽吸物无新鲜血液。具备所有六个预测指标即定义为低风险人群。在我们研究的开发和回顾性验证阶段的162例患者中，所有74例低风险患者预后良好。对111例患者进行的前瞻性验证研究进一步证实了我们预测方法的准确性；52例低风险患者中只有2例预后不良。应用我们的方法应能对急性上消化道出血患者进行更具选择性的管理。
