Klein et al reported a clinical decision rule for identifying a patient with upper gastrointestinal bleeding who probably does not have variceal bleeding. The authors are from Hennepin County Medical Center in Minneapolis.
Patient selection: upper gastrointestinal bleeding in the Emergency Department
Prevalence of variceal bleeding in study population: 10%
Outcome: diagnosis of variceal versus non-variceal source by endoscopy
Criteria for there being a low risk of variceal bleeding - both of the following:
(1) platelet count >= 200,000 per µL
(2) INR <= 1.2
Prevalence of variceal bleeding in patients meeting the rule was 0.6%.
Performance:
• The sensitivity was 97% and specificity 49%.
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