A multicentre development and validation study of a novel lower gastrointestinal bleeding score-The Birmingham Score.
Smith, Samuel C L Bazarova, Alina Ejenavi, Efe Qurashi, Maria Shivaji, Uday N Harvey, Phil R Slaney, Emma McFarlane, Michael Baker, Graham Elnagar, Mohamed
Smith, Samuel C L
Bazarova, Alina
Ejenavi, Efe
Qurashi, Maria
Shivaji, Uday N
Harvey, Phil R
Slaney, Emma
McFarlane, Michael
Baker, Graham
Elnagar, Mohamed
Abstract
Purpose: Lower gastrointestinal bleeding (LGIB) is common and risk stratification scores can guide clinical decision-making. There is no robust risk stratification tool specific for LGIB, with existing tools not routinely adopted. We aimed to develop and validate a risk stratification tool for LGIB.
Methods: Retrospective review of LGIB admissions to three centres between 2010 and 2018 formed the derivation cohort. Using regressional analysis within a machine learning technique, risk factors for adverse outcomes were identified, forming a simple risk stratification score-The Birmingham Score. Retrospective review of an additional centre, not included in the derivation cohort, was performed to validate the score.
Results: Data from 469 patients were included in the derivation cohort and 180 in the validation cohort. Admission haemoglobin OR 1.07(95% CI 1.06-1.08) and male gender OR 2.29(95% CI 1.40-3.77) predicted adverse outcomes in the derivation cohort AUC 0.86(95% CI 0.82-0.90) which outperformed the Blatchford 0.81(95% CI 0.77-0.85), Rockall 0.60(95% CI 0.55-0.65) and AIM65 0.55(0.50-0.60) scores and in the validation cohort AUC 0.80(95% CI 0.73-0.87) which outperformed the Blatchford 0.77(95% CI 0.70-0.85), Rockall 0.67(95% CI 0.59-0.75) and AIM 65 scores 0.61(95% CI 0.53-0.69). The Birmingham Score also performs well at predicting adverse outcomes from diverticular bleeding AUC 0.87 (95% CI 0.75-0.98). A score of 7 predicts a 94% probability of adverse outcome.
Conclusion: The Birmingham Score represents a simple risk stratification score that can be used promptly on patients admitted with LGIB.
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Date
2019-12-16
Type
Article
Other
Other
Subject
Gastroenterology
Citation
Smith SCL, Bazarova A, Ejenavi E, Qurashi M, Shivaji UN, Harvey PR, Slaney E, McFarlane M, Baker G, Elnagar M, Yuzari S, Gkoutos G, Ghosh S, Iacucci M. A multicentre development and validation study of a novel lower gastrointestinal bleeding score-The Birmingham Score. Int J Colorectal Dis. 2020 Feb;35(2):285-293. doi: 10.1007/s00384-019-03459-z. Epub 2019 Dec 16
Journal / Source Title
International Journal of Colorectal Disease
DOI
10.1007/s00384-019-03459-z
PMID
31845024
Publisher
Springer International
Publisher’s URL
https://link.springer.com/journal/384