Related Experiment Video
Updated: Jul 14, 2025
Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System
Published on: October 16, 2013
Safe discharge for patients admitted for lower gastrointestinal bleeding (LGITB): derivation and validation of a
Yue Zhao1, Madeline Yen Min Chee2, Rehena Sultana3
1Ministry of Health Holdings, 110 Sengkang E Way, Singapore, 544886, Singapore. davidzhaoyue2003@gmail.com.
Insights
A new clinical scoring system effectively predicts safe discharge for patients with lower gastrointestinal tract bleeding (LGITB). This tool aids in managing LGITB admissions and improving patient outcomes.
Area of Science:
- Gastroenterology
- Clinical Risk Assessment
- Medical Informatics
Background:
- Lower gastrointestinal tract bleeding (LGITB) is a frequent clinical concern.
- Current guidelines advocate for clinical risk assessment tools in LGITB management.
- Existing scoring systems for LGITB may require further validation or refinement.
Purpose of the Study:
- To develop and validate a novel clinical scoring system for predicting safe discharge in patients admitted for LGITB.
- To compare the performance of this new score against existing LGITB risk assessment tools.
- To enhance clinical decision-making for LGITB patient disposition.
Main Methods:
- Retrospective derivation cohort (n=798) and prospective validation cohort (n=312) of LGITB patients.
- Multivariate binary logistic regression identified key predictors of safe discharge.
- Area Under the Receiver Operating Characteristic Curve (AUROC) analysis compared scoring system performance.
Main Results:
- Key predictors for safe discharge included: absence of prior LGITB, no ischemic heart disease, no rectal bleeding, no syncope/dizziness, and specific systolic blood pressure/hemoglobin levels.
- The novel score achieved an AUROC of 0.907, demonstrating strong predictive power.
- A cutoff of 4 yielded high specificity (97.5%) and positive predictive value (96.4%) for safe discharge prediction.
Conclusions:
- The newly developed LGITB clinical risk score demonstrates robust predictive performance for safe patient discharge.
- This novel score offers a valuable tool for clinicians managing LGITB admissions.
- The score's performance is comparable to established tools like the Oakland score.
Aim:
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.
Methods:
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.
Results:
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.
Conclusion:
The novel LGITB clinical risk score has good predictive performance for safe discharge in patients admitted for LGITB.
Related Concept Videos
01:17Assessment of the Gastrointestinal System I: Subjective Data
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...