PMID- 31379015
OWN - NLM
STAT- MEDLINE
DCOM- 20201113
LR  - 20201113
IS  - 1550-9613 (Electronic)
IS  - 0278-4297 (Linking)
VI  - 39
IP  - 2
DP  - 2020 Feb
TI  - Results of a Prospective Study to Evaluate the Impact of Point-of-Care Ultrasound 
      in the Enhancement of Gastrointestinal Bleeding Risk Scores.
PG  - 279-287
LID - 10.1002/jum.15101 [doi]
AB  - OBJECTIVES: Gastrointestinal (GI) bleeding is a common illness seen in the 
      emergency department. The prognosis varies from self-limited to potentially life 
      threatening. Currently available GI bleeding risk scores have only a modest 
      predictive value, limiting their wide implementation. The aim of this study was 
      to assess the association and capability of point-of-care ultrasound (POCUS) used 
      by emergency physicians to improve common GI bleeding scores for predicting 
      complications and long-term outcomes of patients with GI bleeding, which to our 
      knowledge have never been studied. METHODS: Between August 2015 and April 2017, 
      203 hemodynamically stable patients with acute GI bleeding admitted to the 
      emergency department were prospectively investigated. Using ultrasound, we 
      measured the inferior vena cava diameter, cardiac output with surrogate markers 
      such as the velocity time integral before and after the passive leg-raising test, 
      and the presence of systolic obliteration of the left ventricle. The Rockall and 
      Glasgow-Blatchford scores were calculated for patients with upper GI bleeding and 
      the Velayos score for lower GI bleeding. The patients had follow-up during 
      hospitalization and 30 days later to assess for early and late adverse events 
      (AEs). Then we integrated the ultrasound findings of hypovolemia into the GI 
      bleeding scores, assessing the capability to detect AEs. RESULTS: In our cohort, 
      patients with upper GI bleeding who showed left ventricle kissing walls had a 
      worse evolution, with a greater presence of late AEs (odds ratio [OR], 3.8; 95% 
      confidence interval [CI], 1.32-10.96; P = .01). Patients with lower GI bleeding 
      who showed a collapse of the inferior vena cava (>50%) after passive leg raising 
      had a greater presence of early AEs (OR, 3.6; 95% CI, 1.46-9.00; P = .004). The 
      predictive performance of the Rockall score (receiver operating characteristic 
      analysis: area under the curve [AUC], 77.6%; 95% CI, 66.3%-88.8%) increased with 
      POCUS (AUC, 80.3%; 95% CI, 69.5%-91.1%); that of the Glasgow-Blatchford score 
      (AUC, 72.5%; 95% CI, 59.9%-85.2%) increased with POCUS (AUC, 73.2%; 95% CI, 
      61.1%-85.4%); and that of Velayos score (AUC, 55.7%; 95% CI, 42.5%-69.0%) also 
      increased with POCUS (AUC, 72.2%; 95% CI, 61.1%-83.3%). CONCLUSIONS: The use of 
      POCUS in GI bleeding is feasible and enhances common GI bleeding risk scores, 
      showing better predictive performance in detecting AEs.
CI  - (c) 2019 by the American Institute of Ultrasound in Medicine.
FAU - Tung Chen, Yale
AU  - Tung Chen Y
AUID- ORCID: 0000-0002-5613-3609
AD  - Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain.
AD  - Department of Medicine, Universidad Alfonso X. El Sabio, Madrid, Spain.
FAU - Blancas Gomez-Casero, Rafael
AU  - Blancas Gomez-Casero R
AD  - Department of Medicine, Universidad Alfonso X. El Sabio, Madrid, Spain.
AD  - Department of Critical Care, Hospital Universitario del Tajo, Aranjuez, Spain.
FAU - Quintana Diaz, Manuel
AU  - Quintana Diaz M
AD  - Critical Care, Hospital Universitario La Paz, Madrid, Spain.
FAU - Villen Villegas, Tomas
AU  - Villen Villegas T
AD  - Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain.
AD  - Department of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
FAU - Cobo Mora, Julio
AU  - Cobo Mora J
AD  - Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain.
FAU - Carballo Cardona, Cesar
AU  - Carballo Cardona C
AD  - Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain.
LA  - eng
PT  - Journal Article
DEP - 20190804
PL  - England
TA  - J Ultrasound Med
JT  - Journal of ultrasound in medicine : official journal of the American Institute of 
      Ultrasound in Medicine
JID - 8211547
SB  - IM
MH  - Aged
MH  - Emergency Service, Hospital
MH  - Female
MH  - Gastrointestinal Hemorrhage/*diagnostic imaging
MH  - Humans
MH  - Male
MH  - *Point-of-Care Systems
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Ultrasonography/*methods
OTO - NOTNLM
OT  - gastrointestinal bleeding
OT  - inferior vena cava
OT  - passive leg-raising test
OT  - point-of-care ultrasound
OT  - systolic obliteration of the left ventricle
OT  - velocity time integral
EDAT- 2019/08/06 06:00
MHDA- 2020/11/18 06:00
CRDT- 2019/08/06 06:00
PHST- 2019/04/26 00:00 [received]
PHST- 2019/06/08 00:00 [revised]
PHST- 2019/07/07 00:00 [accepted]
PHST- 2019/08/06 06:00 [pubmed]
PHST- 2020/11/18 06:00 [medline]
PHST- 2019/08/06 06:00 [entrez]
AID - 10.1002/jum.15101 [doi]
PST - ppublish
SO  - J Ultrasound Med. 2020 Feb;39(2):279-287. doi: 10.1002/jum.15101. Epub 2019 Aug 
      4.