Cedars-Sinai Medical Center Predictive Index for Upper GI Hemorrhage

EGD findings

persistent upper GI hemorrhage

4

varices

4

upper GI cancer

4

peptic ulcer disease with visible vessel, nonbleeding

2

peptic ulcer disease with stigmata of recent hemorrhage

2

peptic ulcer disease with spot or clot

1

erosive disease with stigmata of recent hemorrhage

1

angiodysplasia

1

peptic ulcer disease with no stigmata of recent hemorrhage

0

Mallory-Weiss tear, nonbleeding

0

erosive disease

0

normal examination

0

time since onset of symptoms prior to hospitalization

>= 48 hours

0

< 48 hours

1

in hospital

2

hemodynamics

stable

0

intermediate

1

unstable

2

comorbidities

0 or 1

0

2

1

3

2

4 or more

3

peptic ulcer disease

white based break in mucosal surface with obvious depth

clean base with no stigmata of recent hemorrhage

flat ulcer base without pigmentation

spot

nonelevated red, brown or black pigmentation in ulcer bed

adherent clot

thrombus overlying ulcer bed resistant to endoscopic washing

visible vessel, nonbleeding

raised, rounded, relatively smooth-surfaced red or blue pigmented plug in ulcer crater

active

pulsatile blood flow or continuous oozing during endoscopic exam

Mallory-Weiss tear

linear vertical breaks in mucosal surface at GE junction; bleeding or nonbleeding

erosive disease

superficial break in mucosal surface without obvious depth

no stigmata of recent hemorrhage

white-based lesions without associated thrombus, friability or oozing

stigmata of recent hemorrhage

pigment-based lesions with associated thrombus, friability or intermittent oozing of extensive surface area

angiodysplasia

intramucosal pigmented vessels; bleeding or nonbleeding

varices

tortuous columns of blue pigmented submucosal vessels; bleeding or nonbleeding

upper GI cancer

mass

elevated submucosal lesion without break in mucosa or pigmentation; bleeding or nonbleeding

normal endoscopy

no abnormality seen

active bleeding

no diagnosis made due to incomplete visualization from bleeding

cardiac disease

dysrhythmia

acute myocardial infarction

ischemic chest pain

symptomatic congestive heart failure requiring therapy

hepatic disease

acute alcoholic hepatitis

cirrhosis

pulmonary disease

acute respiratory failure

pneumonia

symptomatic obstructive lung disease requiring therapy

renal disease

serum creatinine > 4 mg/dL

dialysis therapy

neurologic disease

delirium

dementia

stroke within 6 months

malignancy

known solid tumor

sepsis

major surgery

within 30 days

age

> 60 years

unstable

meets criteria for continued in hospital treatment

0, 1, 2

low

3 or 4

intermediate

>= 5

high