A multicentre development and validation study of a novel Lower Gastrointestinal Bleeding score-The Birmingham Score

Research output: Contribution to journalArticle

Authors

  • Efe Ejenavi
  • Maria Qurashi
  • Phil R Harvey
  • Emma Slaney
  • Michael McFarlane
  • Graham Baker
  • Mohamed Elnagar
  • Sarah Yuzari
  • George V. Gkoutos

External organisations

  • University Hospitals Birmingham NHS Trust
  • Sandwell & W Birmingham NHSTrust
  • University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
  • Royal Wolverhampton NHS Trust
  • Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • Central Campus

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 2010-2018 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.

Details

Original languageEnglish
Pages (from-to)285–293
JournalInternational journal of colorectal disease
Volume35
Early online date16 Dec 2019
Publication statusPublished - Feb 2020