Pimpl et al developed a scoring system for predicting mortality associated with severe gastroduodenal hemorrhage. This can be used to establish comparable groups of patients. The authors are from Salzburg, Austria,
Parameters used for score:
(1) age of the patient
(2) source of bleeding
(3) site of hemorrhage
(4) activity of hemorrhage
(5) intensity of hemorrhage
(6) severity of associated illnesses
(7) number of associated illnesses
(8) therapy
(9) timeliness of intervention
Points assigned range from 0 to 6, with 6 indicating the most severe finding.
|
Parameter |
Finding |
Points |
|---|---|---|
|
age of the patient |
< 30 years of age |
0 |
|
|
30 – 39 years of age |
1 |
|
|
40 – 49 years of age |
2 |
|
|
50 – 59 years of age |
3 |
|
|
60 – 69 years of age |
4 |
|
|
70 – 80 years |
5 |
|
|
> 80 years |
6 |
|
source of bleeding |
neoplasia |
1 |
|
|
erosion |
2 |
|
|
chronic peptic ulcer |
3 |
|
|
stress ulcer |
4 |
|
|
dieulafoy abnormality |
5 |
|
|
peptic ulcer with a visible artery |
6 |
|
site of hemorrhage |
antrum |
1 |
|
|
angulus (incisura angularis ventriculi) |
2 |
|
|
corpus |
3 |
|
|
anterior wall of the duodenum |
4 |
|
|
cardia |
5 |
|
|
posterior wall of the duodenum |
6 |
|
activity of hemorrhage |
Forrest III (lesion not showing any of the findings for Type I or II) |
1 |
|
|
Forrest II (bleeding ceased, hematin or clot on lesion, visible vessel stump) |
2 |
|
|
Forrest IB (oozing) |
4 |
|
|
Forrest IA (arterial, spurting bleeding) |
6 |
|
intensity of hemorrhage |
no blood units transfused |
0 |
|
|
1 unit transfused |
1 |
|
|
2 units transfused |
2 |
|
|
3 units transfused |
3 |
|
|
4 units transfused |
4 |
|
|
5 units transfused |
5 |
|
|
6 or more units |
6 |
|
severity of associated illnesses |
no associated diseases |
0 |
|
|
mild |
1 |
|
|
metabolic disease |
2 |
|
|
severe chronic disease |
3 |
|
|
malignancy |
4 |
|
|
chronic life-threatening disease |
5 |
|
|
acute life-threatening disease |
6 |
|
number of associated illnesses |
none |
0 |
|
|
1 |
1 |
|
|
2 |
2 |
|
|
3 |
3 |
|
|
4 or more |
4 |
|
therapy |
conservative |
0 |
|
|
sclerotherapy |
1 |
|
|
vagotomy |
2 |
|
|
gastric resection |
3 |
|
|
gastrectomy |
4 |
|
timeliness of intervention |
elective |
0 |
|
|
expedited |
1 |
|
|
emergency |
2 |
where:
• The age ranges given in Table 2, page 102 overlap (30 – 40, 40 – 50, etc.)
• The dieulafoy abnormality is a large, tortuous submucosal artery that ruptures through the mucosa, resulting in profuse hemorrhage.
risk score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 3
• maximum score: 48
• The higher the score, the greater the risk to the patient.
|
Risk Score |
Mortality |
|---|---|
|
< 20 |
0% |
|
20 – 25 |
16.6% +/- 6.2 |
|
25 – 30 |
35.4% +/- 10.6 |
|
30 – 35 |
60% +/- 20.0 |
|
35 – 40 |
83.3% +/- 37.2 |
|
> 40 |
not given |
after Table 10, page 105, Note the overlap in the score ranges at the endpoints.
Specialty: Gastroenterology
