Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children

Abstract

Background and Aim Upper gastrointestinal bleeding is a rare and potentially life‐threatening condition in children. Herein, clinical features and risk factors in children with upper gastrointestinal bleeding were analyzed, and a clinical scoring system was constructed to assess severity. Methods This retrospective cohort study involved 224 children hospitalized with upper gastrointestinal bleeding between January 2012 and April 2018. Demographic data, clinical information, and laboratory test results on admission were statistically examined. Results Out of 224 upper gastrointestinal bleeding cases, 76 were diagnosed as severe and 148 as mild cases according to the rate of blood loss and severity. Severe group was significantly different from mild group in 23 items including age, number of patients aged more than 7 years, and so forth (P < 0.01 or P < 0.05). Positive detection rate of bleeding etiology was gradually decreased (P < 0.01) in relation to delay in timing of endoscopy. Analysis of logistic regression evinced five independent risk factors for severe cases to be associated with poor consciousness, hemoglobin < 80 g/L, hemoglobin drop of > 20 g/L, hematochezia, and anemic appearance (P < 0.01 or P < 0.05). Using these five parameters, a number of scoring models were tested. The most predictive resulted in a scoring system constructed with a total of 16 and a cutoff for intervention of 8. Conclusions Amalgamation of risk factors with the scoring system plays an important role in assessing upper gastrointestinal bleeding severity in children.

Hematemesis in Infants

“…Hence, further large multicenter prospective work is needed to evaluate if this new scoring system is effective in preventing avoidable mortality and morbidity in infantile acute GI bleeding. 11,12 In conclusion, healthcare professionals managing infants need to be aware of the significant morbidity associated with AUGIB, including the rapid deterioration in the clinical state of the infant with AUGIB and the potential for circulatory collapse. The presence of previous surgery on esophagus or stomach, hemoglobin drop, previous oral administration of potentially gastrolesive drugs, melena, poor weight growth, known gastroesophageal reflux disease, negative C-reactive protein, and absence of fever and cough seem to be significant markers of an underlying cause of upper GI hemorrhage that may require therapeutic intervention.…”

“…Theoretically, the BLOVO score could change clinical practice as the adult Rockall and Blatchford scores have done in avoiding unnecessary endoscopy and identifying those patients requiring urgent or semiurgent endoscopic intervention. Hence, further large multicenter prospective work is needed to evaluate if this new scoring system is effective in preventing avoidable mortality and morbidity in infantile acute GI bleeding 11,12 …”

“…Among the analyzed variables, significant preexisting conditions, melena, large hematemesis, tachicardia, drop in hemoglobin, need for fluid bolus, or blood products were identified as significant risk factors for endoscopic intervention and those factors were subsequently weighted and combined to generate the predictive scoring system. Similarly, Zheng et al 12 recently proposed a pediatric scoring system including a few clinical and biochemical parameters, which resulted from the analysis of 224 AUGIB cases in children with a mean age of 7 years. Even if fascinating, these scoring systems cannot be applied to infants, as only few infants were included in the studies.…”