Dataset Information

PROPOSAL FOR A NEW SCORE: HEMORRHOIDAL BLEEDING SCORE (HBS).

ABSTRACT:

Purpose

We conducted a prospective study to evaluate a new hemorrhoidal bleeding score (HBS).

Methods

All consecutive patients who had consulted between May 1, 2016, and June 30, 2017 for bleeding hemorrhoidal disease were prospectively assessed at a proctological department. The study was conducted in two stages. A first stage assessed the validity of the score on a prospective patient cohort. A second stage assessed the interobserver reproducibility of the score on another prospective cohort.

Results

One hundred consecutive patients were studied (57 men, mean age 49.70 years). A positive association between HBS and surgery indication was found (p<0.001). A cut-off value of the score of 5 (≤ 5 vs. > 5) separated patients from surgical to medical-instrumental treatment with a sensitivity and specificity of 75.00% and 81.25% respectively. In the multivariate analysis, only HBS was significantly associated with the operative decision (OR: 12.22). Prolapse was no longer significantly associated with the surgical indication. After a mean follow-up after treatment of 7 months, HBS improved statistically significantly (p<0.0001). For the reproducibility of the score, an additional 30 consecutive patients (13 men, mean age 53.14 years) were enrolled with an excellent agreement between two proctologists (kappa= 0.983).

Conclusion

HBS is sensitive, specific and reproducible. It can assess the severity of hemorrhoidal bleeding. It can discriminate between the most severe surgery-indicated patients, and does so in a more efficient way than the Goligher's prolapse score. It also allows to quantify the extent of change in hemorrhoidal bleeding after treatment.

SUBMITTER: Fathallah N

PROVIDER: S-EPMC8566148 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundGastrointestinal bleeding (GIB) is a common and often serious complication after stroke. Although several risk factors for post-stroke GIB have been identified, no reliable or validated scoring system is currently available to predict GIB after acute stroke in routine clinical practice or clinical trials. In the present study, we aimed to develop and validate a risk model (acute ischemic stroke associated gastrointestinal bleeding score, the AIS-GIB score) to predict in-hospital GIB after acute ischemic stroke.MethodsThe AIS-GIB score was developed from data in the China National Stroke Registry (CNSR). Eligible patients in the CNSR were randomly divided into derivation (60%) and internal validation (40%) cohorts. External validation was performed using data from the prospective Chinese Intracranial Atherosclerosis Study (CICAS). Independent predictors of in-hospital GIB were obtained using multivariable logistic regression in the derivation cohort, and ?-coefficients were used to generate point scoring system for the AIS-GIB. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively.ResultsA total of 8,820, 5,882, and 2,938 patients were enrolled in the derivation, internal validation and external validation cohorts. The overall in-hospital GIB after AIS was 2.6%, 2.3%, and 1.5% in the derivation, internal, and external validation cohort, respectively. An 18-point AIS-GIB score was developed from the set of independent predictors of GIB including age, gender, history of hypertension, hepatic cirrhosis, peptic ulcer or previous GIB, pre-stroke dependence, admission National Institutes of Health stroke scale score, Glasgow Coma Scale score and stroke subtype (Oxfordshire). The AIS-GIB score showed good discrimination in the derivation (0.79; 95% CI, 0.764-0.825), internal (0.78; 95% CI, 0.74-0.82) and external (0.76; 95% CI, 0.71-0.82) validation cohorts. The AIS-GIB score was well calibrated in the derivation (P = 0.42), internal (P = 0.45) and external (P = 0.86) validation cohorts.ConclusionThe AIS-GIB score is a valid clinical grading scale to predict in-hospital GIB after AIS. Further studies on the effect of the AIS-GIB score on reducing GIB and improving outcome after AIS are warranted.