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
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2019-12-16
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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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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
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