Performance of Six Clinical Physiological Scoring Systems In Predicting In-Hospital Mortality In Elderly and Very Elderly Patients With Acute Upper Gastrointestinal Bleeding In Emergency Department

Authors

Po-Han Wu
Shang-Kai Hung
Chien-An Ko
Chia-Peng Chang
Cheng-Ting Hsiao
Jui-Yuan Chung
Hao-Wei Kou
Wan-Hsuan Chen
Chiao-Hsuan Hsieh
Kai-Hsiang Ku
Kai-Hsiang Wu

Language

English

Publication Date

3-11-2023

Journal

Medicina

DOI

10.3390/medicina59030556

PMID

36984556

PMCID

PMC10057917

PubMedCentral® Posted Date

March 2023

PubMedCentral® Full Text Version

Post-print

Abstract

Background and Objectives: The aim of this study is to compare the performance of six clinical physiological-based scores, including the pre-endoscopy Rockall score, shock index (SI), age shock index (age SI), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS), in predicting in-hospital mortality in elderly and very elderly patients in the emergency department (ED) with acute upper gastrointestinal bleeding (AUGIB). Materials and Methods: Patients older than 65 years who visited the ED with a clinical diagnosis of AUGIB were enrolled prospectively from July 2016 to July 2021. The six scores were calculated and compared with in-hospital mortality. Results: A total of 336 patients were recruited, of whom 40 died. There is a significant difference between the patients in the mortality group and survival group in terms of the six scoring systems. MEWS had the highest area under the curve (AUC) value (0.82). A subgroup analysis was performed for a total of 180 very elderly patients (i.e., older than 75 years), of whom 27 died. MEWS also had the best predictive performance in this subgroup (AUC, 0.82). Conclusions: This simple, rapid, and obtainable-by-the-bed parameter could assist emergency physicians in risk stratification and decision making for this vulnerable group.

Keywords

upper gastrointestinal bleeding, elderly patients, emergency department, scoring systems

Published Open-Access

yes

Recommended Citation

Wu, Po-Han; Hung, Shang-Kai; Ko, Chien-An; et al., "Performance of Six Clinical Physiological Scoring Systems In Predicting In-Hospital Mortality In Elderly and Very Elderly Patients With Acute Upper Gastrointestinal Bleeding In Emergency Department" (2023). Faculty, Staff and Student Publications. 2129.
https://digitalcommons.library.tmc.edu/uthmed_docs/2129