Mann et al developed a scoring system in 1983 to help identify patients likely to have a significant finding on upper gastrointestinal tract endoscopy. This was hoped to improve the cost effectiveness of the procedure by reducing unnecessary medical procedures, but it can also be used to prioritize patients at higher risk. The original scoring system was simplified to make the score calculation easier.
Diseases considered "serious":
(1) carcinoma of any kind
(2) ulcer of any kind
(3) strictures of the esophagus, malignant or benign
Parameters included in score using stepwise discriminant analysis:
(1) age
(2) vomiting
(3) gender
(4) history of smoking
(5) previous history of ulcer
(6) presence of hiatal hernia
|
Parameter |
Finding |
Original Points |
Simplified Points |
|
age in years |
<= 49 |
52 |
1 |
|
|
50 - 59 |
103 |
2 |
|
|
60 - 69 |
155 |
3 |
|
|
>= 70 |
206 |
4 |
|
vomiting |
no |
54 |
1 |
|
|
don't know |
107 |
2 |
|
|
yes |
161 |
3 |
|
sex |
female |
70 |
1 |
|
|
male |
141 |
2 |
|
smoking |
no |
36 |
1 |
|
|
don't know |
73 |
2 |
|
|
yes |
109 |
3 |
|
previous ulcer |
no |
39 |
1 |
|
|
don't know |
78 |
2 |
|
|
yes |
117 |
3 |
|
hiatus hernia |
no |
39 |
1 |
|
|
don't know |
79 |
2 |
|
|
yes |
118 |
3 |
original score =
= SUM(original points for the 6 parameters)
simplified score =
= SUM(simplified points for the 6 parameters)
Interpretation:
• minimum score: 290 for original score, 6 for simplified score
• maximum score: 852 for original score, 18 for simplified score
• The higher the score, the more likely that the patient may have a serious disorder.
|
Simplified Score |
Percent with Serious Disease |
|
<= 8 |
1.3% |
|
9 |
17.8% |
|
10 |
17.6% |
|
11 |
29% |
|
12 |
40% |
|
>= 13 |
60.9% |
after Table IV page 939.
|
Threshold Score (Endoscopy Not Done if Score <= Threshold) |
% Reduction in Procedures |
% of Patients with Serious Disease Missed |
|
8 |
33% |
2% |
|
9 |
52% |
19% |
|
10 |
65% |
32% |
|
11 |
78% |
41% |
|
12 |
98% |
62% |
|
18 |
100% |
100% |
after Table IV page 939.
Limitations:
• The score was developed in 1983, prior to advances in endoscopic methods and other diagnostic techniques.
• Not including gastritis and duodenitis as serious diseases may be an oversimplification.
Specialty: Gastroenterology
