Acute upper gastrointestinal bleeding in childhood: development of the Sheffield scoring system to predict need for endoscopic therapy.

BACKGROUND/AIMS: Upper gastrointestinal bleeding (UGIB) is a rare and potentially life-threatening condition in childhood. In adults with UGIB, validated scoring systems exist, but these are not applicable to children. The aim of this study was to construct a clinical scoring system to accurately predict the need for endoscopic haemostatic intervention.

METHODS: A retrospective data collection occurred during a 3-year period at a tertiary children's hospital. A total of 69 patients who had had endoscopic assessment were divided into group 1 (no intervention required) and group 2 (intervention required). A wide range of clinical parameters were collated including preexisting conditions, melaena, haematemesis and degree, transfusion requirement, parameters of hypovolaemia, presenting haemoglobin (Hb), Hb drop during 24 hours, platelet count, coagulation indices, liver function tests, and urea/electrolytes.

RESULTS: Parameters that reached statistical significance for endoscopic intervention (group 1 vs group 2) were the presence of significant preexisting condition, melaena, large haematemesis, heart rate (HR) >20 mean HR for age, prolonged capillary refill time (CRT), Hb drop of >20 g/L, need for fluid bolus, need for blood transfusion (Hb < 80 g/L), and need for other blood products. Using these parameters, a number of scoring models were tested, and the most predictive resulted in a scoring system constructed with a total of 24 and a cutoff for intervention of 8. According to this design, there were 4 false-negatives in the interventional group with 3 false-positives in the noninterventional group. This resulted in a positive predictive value (PPV) of 91.18% (95% confidence interval [CI] 76.3-98.04), negative predictive value (NPV) of 88.57% (95% CI 73.24-96.73), sensitivity of 88.7% (95% CI 73.24-96.73), and specificity of 91.18% (95% CI 76.3-98.04).

CONCLUSIONS: In our study population, we were able to formulate a scoring system with reasonable PPV and NPV to predict the need for endoscopic intervention in acute UGIB in children. Prospective evaluation is now required.