Nikura et al reported a predictive model for rebleeding during follow-up of a patient with occult gastrointestinal bleeding. This can help to identify a patient who may require more aggressive management. The authors are from the University of Tokyo, National Center for Global Health and Medicine, and multiple hospitals in Japan.
Patient selection: occult gastrointestinal bleeding
Parameters:
(1) sex
(2) cirrhosis
(3) warfarin therapy
(4) overt bleeding (hematochezia, melena, hematemesis)
(5) findings on capsule endoscopy
|
Parameter
|
Finding
|
Points
|
|
sex
|
male
|
0
|
|
|
female
|
1
|
|
cirrhosis
|
no
|
0
|
|
|
yes
|
1
|
|
warfarin therapy
|
no
|
0
|
|
|
yes
|
1
|
|
overt bleeding
|
no
|
0
|
|
|
yes
|
1
|
|
capsule endoscopy
|
negative
|
0
|
|
|
positive
|
1
|
where:
• Positive capsule endoscopy: angioectasia, large ulcer, tumor, varices, active bleeding.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A patient with no risk factors probably does not require follow-up.
• A patient with 1 risk factor had follow-up for 1 year at 3 to 6 month intervals.
• A patient with 2 or more risk factors may require a longer follow-up.
Performance:
• The area under the ROC curve is 0.73.
