The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review
Objectives Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision‐making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30‐d...
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| Veröffentlicht in: | Academic emergency medicine 2016-11, Vol.23 (11), p.1218-1227 |
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| creator | Ramaekers, Rosa Mukarram, Muhammad Smith, Christine A. M. Thiruganasambandamoorthy, Venkatesh Gerhardt, Robert T. |
| description | Objectives
Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision‐making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30‐day serious adverse events.
Methods
We searched MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating preendoscopic risk scores and excluded reviews, case reports, and animal studies. The composite outcome included 30‐day mortality, recurrent bleeding, and need for intervention. In two phases (screening and full review), two reviewers independently screened articles for inclusion and extracted patient‐level data. The consensus data were used for analysis. We reported sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios with 95% confidence intervals.
Results
We identified 3,173 articles, of which 16 were included: three studied Glasgow Blatchford score (GBS); one studied clinical Rockall score (cRockall); two studied AIMS65; six compared GBS and cRockall; three compared GBS, a modification of the GBS, and cRockall; and one compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS were 0.98 and 0.16, respectively; for the cRockall they were 0.93 and 0.24, respectively; and for the AIMS65 they were 0.79 and 0.61, respectively. The GBS with a cutoff point of 0 had a sensitivity of 0.99 and a specificity of 0.08.
Conclusion
The GBS with a cutoff point of 0 was superior over other cutoff points and risk scores for identifying low‐risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and, hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB. |
| doi_str_mv | 10.1111/acem.13101 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1834995369</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1834995369</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3931-f936d0c2877312b71357ac4a71b022d1005f99bdbb76a2e4feeaddb4972e46563</originalsourceid><addsrcrecordid>eNp9kcFu1DAQhi0EomXhwgOgkbggpBQ7TuI1t-2yFKSiVrSFY-TYk9YliYPtbLVvxGPisC0HDvgy9vib3-P5CXnJ6BFL653S2B8xzih7RA5ZWfIsFyx_nPa0kllVVvyAPAvhllJaCimekoNcVAXlUh6SX5c3COcejdXRbhG-qW5CcO2cw8G4oN1oNXy14QdcaOcxQHQPBbAyW_QB4WyK2vXpzg6w6dFf46B38AFH5WOPQ4RzFW2KAb7beANX44geTlSI3tkhYoh2UB0cd5hkh-v3sIKLXYjYp6r0Nm4t3j0nT1rVBXxxHxfk6uPmcv0pOz07-bxenWaaS86yVvLKUJ0vheAsbwTjpVC6UII1NM8NSyNopWxM04hK5Vi0iMqYppAiHeZRLcibve7o3c8ptVb3NmjsOjWgm0LNlryQsuSVTOjrf9BbN_n0k5kqOKXLKpmxIG_3lPYuBI9tPXrbK7-rGa1n_-rZv_qPfwl-dS85NT2av-iDYQlge-DOdrj7j1S9Wm--7EV_A9WGpyM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1843008655</pqid></control><display><type>article</type><title>The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Ramaekers, Rosa ; Mukarram, Muhammad ; Smith, Christine A. M. ; Thiruganasambandamoorthy, Venkatesh ; Gerhardt, Robert T.</creator><creatorcontrib>Ramaekers, Rosa ; Mukarram, Muhammad ; Smith, Christine A. M. ; Thiruganasambandamoorthy, Venkatesh ; Gerhardt, Robert T.</creatorcontrib><description>Objectives
Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision‐making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30‐day serious adverse events.
Methods
We searched MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating preendoscopic risk scores and excluded reviews, case reports, and animal studies. The composite outcome included 30‐day mortality, recurrent bleeding, and need for intervention. In two phases (screening and full review), two reviewers independently screened articles for inclusion and extracted patient‐level data. The consensus data were used for analysis. We reported sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios with 95% confidence intervals.
Results
We identified 3,173 articles, of which 16 were included: three studied Glasgow Blatchford score (GBS); one studied clinical Rockall score (cRockall); two studied AIMS65; six compared GBS and cRockall; three compared GBS, a modification of the GBS, and cRockall; and one compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS were 0.98 and 0.16, respectively; for the cRockall they were 0.93 and 0.24, respectively; and for the AIMS65 they were 0.79 and 0.61, respectively. The GBS with a cutoff point of 0 had a sensitivity of 0.99 and a specificity of 0.08.
Conclusion
The GBS with a cutoff point of 0 was superior over other cutoff points and risk scores for identifying low‐risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and, hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB.</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/acem.13101</identifier><identifier>PMID: 27640399</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Clinical outcomes ; Decision Making ; Emergency medical care ; Emergency Service, Hospital ; Endoscopy ; Female ; Gastrointestinal diseases ; Gastrointestinal Hemorrhage - diagnosis ; Health risk assessment ; Humans ; Male ; Medical screening ; Outcome Assessment (Health Care) ; Predictive Value of Tests ; Prospective Studies ; Retrospective Studies ; Risk Assessment - methods ; Sensitivity and Specificity ; Systematic review</subject><ispartof>Academic emergency medicine, 2016-11, Vol.23 (11), p.1218-1227</ispartof><rights>2016 by the Society for Academic Emergency Medicine</rights><rights>2016 by the Society for Academic Emergency Medicine.</rights><rights>Copyright Wiley Subscription Services, Inc. Nov 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3931-f936d0c2877312b71357ac4a71b022d1005f99bdbb76a2e4feeaddb4972e46563</citedby><cites>FETCH-LOGICAL-c3931-f936d0c2877312b71357ac4a71b022d1005f99bdbb76a2e4feeaddb4972e46563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Facem.13101$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Facem.13101$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27640399$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramaekers, Rosa</creatorcontrib><creatorcontrib>Mukarram, Muhammad</creatorcontrib><creatorcontrib>Smith, Christine A. M.</creatorcontrib><creatorcontrib>Thiruganasambandamoorthy, Venkatesh</creatorcontrib><creatorcontrib>Gerhardt, Robert T.</creatorcontrib><title>The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Objectives
Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision‐making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30‐day serious adverse events.
Methods
We searched MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating preendoscopic risk scores and excluded reviews, case reports, and animal studies. The composite outcome included 30‐day mortality, recurrent bleeding, and need for intervention. In two phases (screening and full review), two reviewers independently screened articles for inclusion and extracted patient‐level data. The consensus data were used for analysis. We reported sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios with 95% confidence intervals.
Results
We identified 3,173 articles, of which 16 were included: three studied Glasgow Blatchford score (GBS); one studied clinical Rockall score (cRockall); two studied AIMS65; six compared GBS and cRockall; three compared GBS, a modification of the GBS, and cRockall; and one compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS were 0.98 and 0.16, respectively; for the cRockall they were 0.93 and 0.24, respectively; and for the AIMS65 they were 0.79 and 0.61, respectively. The GBS with a cutoff point of 0 had a sensitivity of 0.99 and a specificity of 0.08.
Conclusion
The GBS with a cutoff point of 0 was superior over other cutoff points and risk scores for identifying low‐risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and, hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB.</description><subject>Clinical outcomes</subject><subject>Decision Making</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastrointestinal diseases</subject><subject>Gastrointestinal Hemorrhage - diagnosis</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Male</subject><subject>Medical screening</subject><subject>Outcome Assessment (Health Care)</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Sensitivity and Specificity</subject><subject>Systematic review</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi0EomXhwgOgkbggpBQ7TuI1t-2yFKSiVrSFY-TYk9YliYPtbLVvxGPisC0HDvgy9vib3-P5CXnJ6BFL653S2B8xzih7RA5ZWfIsFyx_nPa0kllVVvyAPAvhllJaCimekoNcVAXlUh6SX5c3COcejdXRbhG-qW5CcO2cw8G4oN1oNXy14QdcaOcxQHQPBbAyW_QB4WyK2vXpzg6w6dFf46B38AFH5WOPQ4RzFW2KAb7beANX44geTlSI3tkhYoh2UB0cd5hkh-v3sIKLXYjYp6r0Nm4t3j0nT1rVBXxxHxfk6uPmcv0pOz07-bxenWaaS86yVvLKUJ0vheAsbwTjpVC6UII1NM8NSyNopWxM04hK5Vi0iMqYppAiHeZRLcibve7o3c8ptVb3NmjsOjWgm0LNlryQsuSVTOjrf9BbN_n0k5kqOKXLKpmxIG_3lPYuBI9tPXrbK7-rGa1n_-rZv_qPfwl-dS85NT2av-iDYQlge-DOdrj7j1S9Wm--7EV_A9WGpyM</recordid><startdate>201611</startdate><enddate>201611</enddate><creator>Ramaekers, Rosa</creator><creator>Mukarram, Muhammad</creator><creator>Smith, Christine A. M.</creator><creator>Thiruganasambandamoorthy, Venkatesh</creator><creator>Gerhardt, Robert T.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201611</creationdate><title>The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review</title><author>Ramaekers, Rosa ; Mukarram, Muhammad ; Smith, Christine A. M. ; Thiruganasambandamoorthy, Venkatesh ; Gerhardt, Robert T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3931-f936d0c2877312b71357ac4a71b022d1005f99bdbb76a2e4feeaddb4972e46563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Clinical outcomes</topic><topic>Decision Making</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastrointestinal diseases</topic><topic>Gastrointestinal Hemorrhage - diagnosis</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Male</topic><topic>Medical screening</topic><topic>Outcome Assessment (Health Care)</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Sensitivity and Specificity</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramaekers, Rosa</creatorcontrib><creatorcontrib>Mukarram, Muhammad</creatorcontrib><creatorcontrib>Smith, Christine A. M.</creatorcontrib><creatorcontrib>Thiruganasambandamoorthy, Venkatesh</creatorcontrib><creatorcontrib>Gerhardt, Robert T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramaekers, Rosa</au><au>Mukarram, Muhammad</au><au>Smith, Christine A. M.</au><au>Thiruganasambandamoorthy, Venkatesh</au><au>Gerhardt, Robert T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2016-11</date><risdate>2016</risdate><volume>23</volume><issue>11</issue><spage>1218</spage><epage>1227</epage><pages>1218-1227</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Objectives
Risk stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using preendoscopic risk scores can aid ED physicians in disposition decision‐making. We conducted a systematic review to assess the predictive value of preendoscopic risk scores for 30‐day serious adverse events.
Methods
We searched MEDLINE, PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating preendoscopic risk scores and excluded reviews, case reports, and animal studies. The composite outcome included 30‐day mortality, recurrent bleeding, and need for intervention. In two phases (screening and full review), two reviewers independently screened articles for inclusion and extracted patient‐level data. The consensus data were used for analysis. We reported sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios with 95% confidence intervals.
Results
We identified 3,173 articles, of which 16 were included: three studied Glasgow Blatchford score (GBS); one studied clinical Rockall score (cRockall); two studied AIMS65; six compared GBS and cRockall; three compared GBS, a modification of the GBS, and cRockall; and one compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS were 0.98 and 0.16, respectively; for the cRockall they were 0.93 and 0.24, respectively; and for the AIMS65 they were 0.79 and 0.61, respectively. The GBS with a cutoff point of 0 had a sensitivity of 0.99 and a specificity of 0.08.
Conclusion
The GBS with a cutoff point of 0 was superior over other cutoff points and risk scores for identifying low‐risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and, hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27640399</pmid><doi>10.1111/acem.13101</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Academic emergency medicine, 2016-11, Vol.23 (11), p.1218-1227 |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Clinical outcomes Decision Making Emergency medical care Emergency Service, Hospital Endoscopy Female Gastrointestinal diseases Gastrointestinal Hemorrhage - diagnosis Health risk assessment Humans Male Medical screening Outcome Assessment (Health Care) Predictive Value of Tests Prospective Studies Retrospective Studies Risk Assessment - methods Sensitivity and Specificity Systematic review |
| title | The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review |
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