A multicentre development and validation study of a novel lower gastrointestinal bleeding score—The Birmingham Score

• Published in: International journal of colorectal disease Vol. 35; no. 2; pp. 285 - 293
• Main Authors: Smith, Samuel C. L., Bazarova, Alina, Ejenavi, Efe, Qurashi, Maria, Shivaji, Uday N., Harvey, Phil R., Slaney, Emma, McFarlane, Michael, Baker, Graham, Elnagar, Mohamed, Yuzari, Sarah, Gkoutos, Georgios, Ghosh, Subrata, Iacucci, Marietta
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2020; Springer
• Subjects: Analysis; Decision-making; Gastroenterology; Gastrointestinal bleeding; Hepatology; Internal Medicine; Machine learning; Medicine; Medicine & Public Health; Original Article; Proctology; Risk factors; Surgery; Lower gastrointestinal bleeding; Risk factors; Risk stratification; Triaging tool
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-019-03459-z

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 and 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.