Ed's Lower GI Bleed Score


A Prospective Multi-Centre Audit Predicting Patient Outcomes in Lower-GastroIntestinal Bleeding
Chief Investigator: Ed Fitzgerald, Specialist Registrar, General Surgery, Chelsea & Westminster NHS Hospital Trust
Introduction
Lower gastrointestinal bleeding (LGIB) is a common manifestation of numerous gastrointestinal conditions. It has a lifetime incidence of approximately 15% in the Western world. Unlike UGI bleeding, there are currently no commonly accepted triaging models or scoring systems stratify patients. In most cases, bleeding from the colon and rectum is self-limiting, resulting from benign pathology, and requiring no specific therapy. However severe episodes may require more aggressive intervention and intensive care unit (ICU) admission.

We have previously undertaken a retrospective single-centre audit of simple clinical factors at admission and within 24-hours. Stepwise multivariate logistic regression analysis was utilised to identify predictive factors, with an area under the receiver operating characteristic curve for the resulting model of 0.79 (95% CI 0.70 – 0.90).
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Hypothesis
Patients at high risk of adverse outcomes from LGIB can be predicted through simple, standard clinical variables recorded at admission and within the first 24-hours.

Methods
Prospective multi-centre audit to examine these identified predictors across a number of hospitals in a larger patient cohort. This study would benefit from a collaborative approach across a number of centres, and would ideally be co-ordinated by a steering group to oversee the project.

Outcomes
  1. Severe bleeding (defined as bleeding within first 24-hours, requirement of blood transfusion, decrease in haematocrit ≥20%, or recurrent bleeding ≥24-hours of stability)
  2. Adverse outcome (defined as ITU admission, emergency surgery, and death).
Next Steps
I am forming a steering committee to:
  1. Sort out methodology
  2. Design data collection forms
  3. Write the study proposal for audit approval
  4. Design an information leaflet / poster to help with study recruitment
When all this is in hand, I would hope that data collection could be started in January.

How to get involved
If you want to be involved either in the steering group or the data collection, send an email to edwardfitzgerald [at] doctors.org.uk

Those who have expressed an interest so far are:
Tamzin Cuming
Thomas Wiggins
Helene Dent
Anisha Shukha
Hilary West
Alice Murray
Hew Torrance
Billy Leung

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Ed's Lower GI Bleed Score


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