Lopez-Herce et al modified the risk index of Tryba et al for acute upper gastrointestinal bleeding for use in children. The risk score for a patient can help determine if prophylaxis is indicated and can help gauge its effectiveness. The authors are from La Paz Children's Hospital in Madrid, Spain.
Parameters:
(1) primary, very significant: 10 factors scored from 7 to 15 points
(2) secondary, moderate significance: 9 factors scored from 3 to 5 points
(3) mild, dependent on the presence of primary and secondary risk factors: 7 factors scored 2 points
Patient evaluation is performed during the first 24 hours of the patient's admission (I assume to the intensive care unit).
|
Level |
Parameter |
Points |
|
severe |
acute renal insufficiency (serum creatinine > 4 times the upper limit of the normal reference range for age) |
15 |
|
|
acute renal insufficiency (serum creatinine > 2 times the upper limit of the normal reference range for age) |
7 |
|
|
burns involving > 25% of body surface area |
15 |
|
|
head injury with neurologic deficit |
15 |
|
|
severe bacterial infection |
10 |
|
|
severe multiple trauma |
10 |
|
|
cardiogenic shock |
10 |
|
|
severe chronic renal disease |
10 |
|
|
severe chronic gastrointestinal disease |
10 |
|
|
respiratory insufficiency |
7 |
|
moderate |
transplantation (kidney, etc) |
5 |
|
|
coagulation disorder (DIC; or platelet count < 50,000 per µL; or aPTT > 2 times upper limit reference range; or prothrombin activity < 50%) |
5 |
|
|
neurogenic shock |
5 |
|
|
brain hemorrhage |
5 |
|
|
transfusion > 40 mL/kg of blood |
5 |
|
|
heparin therapy |
3 |
|
|
hemoglobin < 9 g/dL for > 24 hours |
3 |
|
|
hypotension for > 1 hour (systolic blood pressure < 65 mm for infants < 1 year; < 75 mm Hg if >= 1 year) |
(hours) * 2 |
|
|
hypertension for > 1 day (systolic blood pressure > 30 mm Hg above the upper 2 SD for age) |
(days) * 2 |
|
mild (dependent) |
corticosteroid therapy |
2 |
|
|
second laparotomy (re-operation) |
2 |
|
|
adynamic ileus |
2 |
|
|
septic shock |
2 |
|
|
hypovolemic shock |
2 |
|
|
anaphylactic shock |
2 |
|
|
head injury in multiple trauma patient |
2 |
where:
• The prothrombin activity is usually not performed in the US. I will use PT > 2 times the upper limit of normal reference range (same as for aPTT)
• I added "for > 1 day" to hypertension to mimic the pattern of hypotension.
• I only scored once for head injury (head injury with deficit took precedence over head injury with multiple trauma).
risk score =
= SUM(points for all 26 indicators)
Interpretation:
• minimum score: 0
• maximum score: 165+ (depending on hours of hypotension, days of hypertension)
• A high score is associated with a high risk of bleeding.
• I could not find a correlate between the risk score and actual percent of children with hemorrhage.
Specialty: Gastroenterology
