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Acute upper gastrointestinal bleeding in childhood: development of the Sheffield scoring system to predict need for
Mike A Thomson1, Neme Leton, Dalia Belsha
1Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
Insights
A new scoring system accurately predicts the need for endoscopic intervention in pediatric upper gastrointestinal bleeding (UGIB). This tool aids clinicians in managing this rare but serious condition in children.
Area of Science:
- Pediatric Gastroenterology
- Clinical Scoring Systems
- Gastrointestinal Hemorrhage
Background:
- Upper gastrointestinal bleeding (UGIB) is a rare, life-threatening condition in children.
- Existing scoring systems for UGIB in adults are not applicable to pediatric patients.
Purpose of the Study:
- To develop and validate a clinical scoring system for predicting the necessity of endoscopic hemostatic intervention in pediatric UGIB.
- To improve the management of acute UGIB in children.
Main Methods:
- Retrospective data collection from 69 pediatric patients undergoing endoscopic assessment at a tertiary children's hospital over 3 years.
- Analysis of clinical parameters including pre-existing conditions, bleeding symptoms, hemodynamic status, and laboratory values.
- Development and testing of various scoring models to identify the most predictive for intervention.
Main Results:
- Significant predictors for endoscopic intervention included pre-existing conditions, melaena, severe haematemesis, heart rate, capillary refill time, hemoglobin drop, and need for fluid/blood transfusion.
- The developed scoring system demonstrated a positive predictive value (PPV) of 91.18% and a negative predictive value (NPV) of 88.57%.
- The system achieved a sensitivity of 88.7% and specificity of 91.18% for predicting the need for intervention.
Conclusions:
- A novel scoring system was formulated with reasonable predictive values for identifying children requiring endoscopic intervention for acute UGIB.
- Prospective evaluation of this scoring system is warranted to confirm its clinical utility.
Background/Aims:
Upper gastrointestinal bleeding (UGIB) is a rare and potentially life-threatening condition in childhood. In adults with UGIB, validated scoring systems exist, but these are not applicable to children. The aim of this study was to construct a clinical scoring system to accurately predict the need for endoscopic haemostatic intervention.
Methods:
A retrospective data collection occurred during a 3-year period at a tertiary children's hospital. A total of 69 patients who had had endoscopic assessment were divided into group 1 (no intervention required) and group 2 (intervention required). A wide range of clinical parameters were collated including preexisting conditions, melaena, haematemesis and degree, transfusion requirement, parameters of hypovolaemia, presenting haemoglobin (Hb), Hb drop during 24 hours, platelet count, coagulation indices, liver function tests, and urea/electrolytes.
Results:
Parameters that reached statistical significance for endoscopic intervention (group 1 vs group 2) were the presence of significant preexisting condition, melaena, large haematemesis, heart rate (HR) >20 mean HR for age, prolonged capillary refill time (CRT), Hb drop of >20 g/L, need for fluid bolus, need for blood transfusion (Hb < 80 g/L), and need for other blood products. Using these parameters, a number of scoring models were tested, and the most predictive resulted in a scoring system constructed with a total of 24 and a cutoff for intervention of 8. According to this design, there were 4 false-negatives in the interventional group with 3 false-positives in the noninterventional group. This resulted in a positive predictive value (PPV) of 91.18% (95% confidence interval [CI] 76.3-98.04), negative predictive value (NPV) of 88.57% (95% CI 73.24-96.73), sensitivity of 88.7% (95% CI 73.24-96.73), and specificity of 91.18% (95% CI 76.3-98.04).
Conclusions:
In our study population, we were able to formulate a scoring system with reasonable PPV and NPV to predict the need for endoscopic intervention in acute UGIB in children. Prospective evaluation is now required.
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