Original Contribution Clinical triage decision vs risk scores in predicting the need for endotherapy in upper gastrointestinal bleeding ☆,☆☆ Farees T. Farooq MD a,b , Michael H. Lee MD b , Ananya Das MD c , Rahul Dixit MD b , Richard C.K. Wong MBBS b, ⁎ a Gastro One, Memphis, TN 38138, USA b Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center, Cleveland, OH 44106-5066, USA c Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ 85259, USA Received 13 April 2010; revised 3 November 2010; accepted 4 November 2010 Abstract Background: Acute upper gastrointestinal hemorrhage (UGIH) is a common reason for hospitalization with substantial associated morbidity, mortality, and cost. Differentiation of high- and low-risk patients using established risk scoring systems has been advocated. The aim of this study was to determine whether these scoring systems are more accurate than an emergency physician's clinical decision making in predicting the need for endoscopic intervention in acute UGIH. Methods: Patients presenting to a tertiary care medical center with acute UGIH from 2003 to 2006 were identified from the hospital database, and their clinical data were abstracted. One hundred ninety-five patients met the inclusion criteria and were included in the analysis. The clinical Rockall score and Blatchford score (BS) were calculated and compared with the clinical triage decision (intensive care unit vs non–intensive care unit admission) in predicting the need for endoscopic therapy. Results: Clinical Rockall score greater than 0 and BS greater than 0 were sensitive predictors of the need for endoscopic therapy (95% and 100%) but were poorly specific (9% and 4%), with overall accuracies of 41% and 39%. At higher score cutoffs, clinical Rockall score greater than 2 and BS greater than 5 remained sensitive (84% and 87%) and were more specific (29% and 33%), with overall accuracies of 48% and 52%. Clinical triage decision, as a surrogate for predicting the need for endoscopic therapy, was moderately sensitive (67%) and specific (75%), with an overall accuracy (73%) that exceeded both risk scores. Conclusions: The clinical use of risk scoring systems in acute UGIH may not be as good as clinical decision making by emergency physicians. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Acute upper gastrointestinal hemorrhage (UGIH) is a common clinical problem accounting for 250000 hospitaliza- tions annually in the United States alone [1-3]. The frequency and severity of this problem and its associated costs impose a significant burden on limited health care resources. As with ☆ Presented at an oral session at Digestive Disease Week 2007, Washington, DC, and published in abstract form (Gastrointest Endosc 2007;65:AB122.) ☆☆ No authors have any conflicts of interest to disclose. There are no competing interests to disclose. ⁎ Corresponding author. E-mail address: richard.wong@case.edu (R.C.K. Wong). www.elsevier.com/locate/ajem 0735-6757/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.ajem.2010.11.007 American Journal of Emergency Medicine (2012) 30, 129–134