In:
Digestive Endoscopy, Wiley, Vol. 35, No. 6 ( 2023-09), p. 777-789
Abstract:
Stigmata of recent hemorrhage (SRH) directly indicate a need for endoscopic therapy in acute lower gastrointestinal bleeding (LGIB). Colonoscopy would be prioritized for patients with highly suspected SRH, but the predictors of colonic SRH remain unclear. We aimed to construct a predictive model for the efficient detection of SRH using a nationwide cohort. Methods We retrospectively analyzed 8360 patients admitted through hospital emergency departments for acute LGIB in the CODE BLUE‐J Study (49 hospitals throughout Japan). All patients underwent inpatient colonoscopy. To develop an SRH predictive model, 4863 patients were analyzed. Baseline characteristics, colonoscopic factors (timing, preparation, and devices), and computed tomography (CT) extravasation were extensively assessed. The performance of the model was externally validated in 3497 patients. Results Colonic SRH was detected in 28% of patients. A novel predictive model for detecting SRH ( CS‐NEED score: C olono S copic factors, N o abdominal pain, E levated PT‐INR, E xtravasation on CT, and D OAC use) showed high performance (area under the receiver operating characteristic curve [AUC] 0.74 for derivation and 0.73 for external validation). This score was also highly predictive of active bleeding (AUC 0.73 for derivation and 0.76 for external validation). Patients with low (0–6), intermediate (7–8), and high (9–12) scores in the external validation cohort had SRH identification rates of 20%, 31%, and 64%, respectively ( P 〈 0.001 for trend). Conclusions A novel predictive model for colonic SRH identification ( CS‐NEED score) can specify colonoscopies likely to achieve endoscopic therapy in acute LGIB. Using the model during initial management would contribute to finding and treating SRH efficiently.
Type of Medium:
Online Resource
ISSN:
0915-5635
,
1443-1661
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2020071-7
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