Adamopoulos et al developed a simple score for evaluating a patient with acute upper gastrointestinal bleeding. It can help to identify a patient who should undergo urgent endoscopy. The authors are from the University of Athens and Sotira General Hospital in Athens.
Patient selection: acute upper GI bleeding
Parameters:
(1) fresh blood in nasogastric tube
(2) hemodynamic instability
(3) hemoglobin in g/dL
(4) white blood cell count per microliter
Parameter
Finding
Points
fresh blood in NG tube
no
0
yes
6
hemodynamic instability
no
0
yes
4
hemoglobin
>= 8 g/dL
0
< 8 g/dL
4
WBC count
<= 12,000 per µL
0
> 12,000 per µL
3
score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• The higher the score the greater the need for upper gastrointestinal tract endoscopy.
• A score < 7 indiscates that active bleeding is unlikely.
• A score >= 11 indicates that active bleeding is present.
Performance:
• A score >= 11 has a sensitivity of 96% and specificity of 98% (at least in the study).
• The negative predictive value was 98%.
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