Magalhaes et al reported the RHEMITT score for evaluating a patient with mid-gastrointestinal bleeding studied with small bowel capsule endoscopy. This can help to identify a patient at increased risk for rebleeding. The authors are from Hospital Senhora da Oliveira, University of Minho, and University of Porto in Portugal.
RHEMITT is an acronym for renal failure, heart disease, major bleed, incomplete capsule, tobacco use and treatment.
Patient selection: occult small bowel hemorrhage
Parameters:
(1) renal disease
(2) heart failure
(3) lesion (after Saurin et al)
(4) major bleed (drop in hemoglobin >= 2.0 g/dL or >= 2 units of blood transfused)
(5) incomplete capsule (incomplete exam)
(6) tobacco use
(7) endoscopic treatment
|
Parameter
|
Finding
|
Points
|
|
renal disease
|
no
|
0
|
|
|
yes
|
3
|
|
heart failure
|
no
|
0
|
|
|
yes
|
1
|
|
lesion
|
P0
|
0
|
|
|
P1
|
2
|
|
|
P2
|
3
|
|
major bleed
|
no
|
0
|
|
|
yes
|
5
|
|
incomplete capsule
|
no
|
0
|
|
|
yes
|
2
|
|
tobacco use
|
no
|
0
|
|
|
yes
|
2
|
|
endoscopic treatment
|
no
|
0
|
|
|
yes
|
2
|
where:
• P0 lesions: nodules without mucosal breaks; lymphangiecastias; no bleeding potential
• P1: red spots; small or isolated erosions
• P2: angioectasia; ulcers; tumors; other lesions with high bleeding potential
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
|
Score
|
Risk Group
|
Rebleeding
|
|
0 to 3
|
low
|
0%
|
|
4 to 10
|
intermediate
|
25%
|
|
11 to 18
|
high
|
64%
|
Performance:
• The area under the ROC curve is 0.84.
