Provenzale et al developed a scoring system for predicting mortality in a patient with acute upper gastrointestinal bleeding. This can help identify a patient who may benefit from more aggressive management. The authors are from the University of North Carolina in Chapel Hill.
Parameters:
(1) melena (black, tarry stool)
(2) hematochezia (bright red blood in stool)
(3) change in hematocrit
(4) duration of bleeding in hours
(5) systolic blood pressure
(6) chronic renal disease
(7) hepatic encephalopathy
(8) spider angiomata
(9) prothrombin time in seconds
|
Parameter |
Finding |
Points |
|
melena |
absent |
0 |
|
|
present |
-1 |
|
hematochezia |
absent |
0 |
|
|
present |
1 |
|
drop in hematocrit |
< 5% |
0 |
|
|
>= 5% |
1 |
|
duration of bleeding in hours |
> 12 hours |
0 |
|
|
3 - 12 hours |
1 |
|
|
< 3 hours |
2 |
|
systolic blood pressure |
>= 100 mm Hg |
0 |
|
|
90 - 99 mm Hg |
1 |
|
|
80 - 89 mm Hg |
2 |
|
|
< 80 mm Hg |
3 |
|
chronic renal disease |
absent |
0 |
|
|
present |
1 |
|
hepatic encephalopathy |
absent |
0 |
|
|
present |
1 |
|
spider angiomata |
absent |
0 |
|
|
present |
1 |
|
prothrombin time in seconds |
< 12 seconds |
0 |
|
|
12 to 15 seconds |
1 |
|
|
> 15 seconds |
2 |
from Table 3, page 29
where:
• I assume that 12 seconds is the upper limit for the prothrombin reference range. I will adapt the implementation to give the cutoff points as the upper limit of the reference range (ULN) and ULN + 3.
• The point assignment for the hematocrit should be based on untransfused values.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: -1
• maximum score: 11
• The higher the score, the greater the mortality rate.
|
Total Score |
Mortality Rate |
|
-1 or 0 |
2% |
|
1 |
4% |
|
2 |
7% |
|
3 |
12% |
|
4 |
19% |
|
5 |
30% |
|
6 |
44% |
|
7 |
59% |
|
8 |
72% |
|
9 |
82% |
|
10 |
89% |
|
11 |
94% |
from Table 5, page 30
Specialty: Gastroenterology
