Ahmad Akram I, El Sabagh Ahmed, Zhang Jennie, Caplan Claire, Al-Dwairy Ahmad, Bakain Tarek, Buchanan Faith, Fisher Lea, Wilbur Andrew, Marshall Samantha, Buechner Garrett, Hamzeh Malaak, Dhanjal Rachna, Boos Alexander, Sequeira Lynette
Digestive Disease Institute, Cleveland Clinic Florida, Weston, Florida, USA.
Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA.
Gastroenterol Res Pract. 2025 Jan 3;2025:5657404. doi: 10.1155/grp/5657404. eCollection 2025.
Lower gastrointestinal bleeding (LGIB) frequently leads to emergency department (ED) visits and hospitalizations, encompassing a spectrum of outcomes from spontaneous resolution to intrahospital mortality. 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. A retrospective analysis of all gastrointestinal bleeding cases presented at three EDs in 2020 was conducted, focusing specifically on patients with LGIB. The SHAPE 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. 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 SHAPE 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]). The SHAPE 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.
下消化道出血（LGIB）常常导致患者前往急诊科（ED）就诊并住院，其结局范围涵盖从自然缓解到院内死亡。本研究的目的是验证一种旨在识别低风险LGIB病例的评分系统，以便能从急诊科安全出院。对2020年在三家急诊科就诊的所有胃肠道出血病例进行了回顾性分析，特别关注LGIB患者。SHAPE评分纳入了收缩压、血红蛋白水平、抗血小板或抗凝药物的使用、脉搏率以及直肠便血次数等因素。在1112例到急诊科就诊的LGIB患者中，55例住院，20例需要输血，15例接受了结肠镜检查，1例接受了介入放射学检查，2例患者死亡。采用截断值为1的SHAPE评分，预测住院和院内干预需求时，特异性为78.5%（95%置信区间[75.8 - 81.0]），敏感性为76.8%（95%置信区间[63.6 - 87.0]），阳性预测值（PPV）为17.0%（95%置信区间[12.6 - 22.2]），阴性预测值（NPV）为98.3%（95%置信区间[97.2 - 99.1]）。当考虑7天内以相同症状再次到急诊科就诊时，该评分的特异性为78.8%（95%置信区间[76.0 - 81.3]），敏感性为68.6%（95%置信区间[56.4 - 79.1]），PPV为19%（95%置信区间[14.3 - 24.4]），NPV为97.2%（95%置信区间[95.8 - 98.2]）。SHAPE评分在预测低风险LGIB病例方面显示出潜力，对住院、院内干预需求以及再次到急诊科就诊具有较高的NPV。然而，鉴于干预发生率较低以及研究人群和设计存在局限性，对这些发现应谨慎解读。
