Marks et al reported the London Haemostat Score (LMS) to identify a patient with acute upper gastrointestinal bleeding who needs expedited endoscopy. The authors are from Imperial College Healthcare and Imperial College London.
Patient selection: acute upper gastrointestinal bleeding
Parameters:
(1) heart rate in beats per minute
(2) hemoglobin in g/L
(3) urea to creatinine ratio
(4) chronic liver disease
(5) serum CRP in mg/L
(6) alternate diagnosis for anemia, hemodynamic instability or rise in urea
urea to creatinine ratio =
= (serum urea in mmol/L) * 1000 / (serum creatinine in µmol/L)
|
Parameter
|
Finding
|
Points
|
|
heart rate
|
<= 100 beats per minute
|
0
|
|
|
> 100 beats per minute (tachycardia)
|
2
|
|
hemoglobin
|
< 100 g/L
|
4
|
|
|
100 to 125 g/L
|
2
|
|
|
> 125 g/L
|
0
|
|
urea to creatinine ratio
|
<= 100
|
0
|
|
|
> 100
|
4
|
|
chronic liver disease
|
no
|
0
|
|
|
yes
|
3
|
|
serum CRP
|
<= 50 mg/L
|
0
|
|
|
> 50 mg/L
|
-3
|
|
alternate diagnosis
|
no
|
0
|
|
|
yes
|
-6
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -9
• maximum score: 13
• The maximum Youden index was for a score >= 4 (sensitivity 0.89, specificity0.67).
• A score <= 0 has a NPV close to 1.0. The patient can usually have delayed endoscopy.
• The higher the score the greater the risk of bleeding. The patient should have endoscopy within 24 hours.
Performance:
• The area under the ROC curve was 0.82 in the derivation and 0.80 in the validation cohorts.
