Title: Which scoring systems are useful for predicting the prognosis of lower gastrointestinal
bleeding? Old and New
Version: 2 Date: 08 Dec 2024
Reviewer's report:
Which Scoring Systems Are Useful for Predicting the Prognosis of Lower Gastrointestinal
Bleeding? Old and New
The authors conducted a large retrospective study evaluating the performance of scoring
systems in predicting outcomes for patients presenting to the emergency department with
lower gastrointestinal bleeding (LGIB). The inclusion of recently developed scoring systems
(e.g., CHAMPS, SHA2PE) adds value to the study and provides important insights into LGIB
risk stratification. However, there are several issues that should be addressed to improve the
manuscript.
Major concerns
Patient Selection
1. The exclusion of patients without colonoscopic confirmation of LGIB may introduce selection
bias, especially in cases where endoscopy was contraindicated due to poor general conditions.
2. The study includes patients with malignancies but does not provide staging data. Malignancy
stages can significantly impact the mortality rate, which is the primary outcome of the study.
Consider adding this data or discussing its potential impact as a limitation.
3. Please clarify if the exclusion criteria (e.g., upper gastrointestinal bleeding or variceal
bleeding) were consistently and rigorously applied across all cases in the dataset.
Comparison Between Scoring Systems
4. The choice of AUROC as the primary metric for comparison is appropriate. However, please
provide the AUROCs for each scoring system and the p-values comparing the scoring systems
for each outcome. For example, compare AIMS 65 with Oakland for predicting 30-day mortality
(e.g., see Chang A, et al., Clin Endosc. 2021). Consider providing these comparisons in an
additional table or as part of Figures 2 & 3") could be more helpful
Statistical Analysis
5. While the study uses multivariate logistic regression effectively, the Hosmer-Lemeshow test
results and their implications for model fit should be reported in greater detail.
6. Adjustments for potential confounding variables (e.g., anticoagulant use, comorbidities) are
acknowledged, but it would be beneficial to expand on interactions between these factors.
Discussion
7. It would be helpful to discuss why certain scores, such as SHA2PE for prolonged hospital
stays, performed better than others and how this aligns with clinical utility.
8. While the results favor AIMS 65, CHAMPS, and ABC for mortality prediction, the discussion
could benefit from an exploration of why these scores excel despite variations in included
variables. For example, the simplicity of AIMS 65 may enhance its clinical adoption compared
to the complexity of CHAMPS.
Title: Which scoring systems are useful for predicting the prognosis of lower gastrointestinal
bleeding? Old and New
Version: 2 Date: 08 Dec 2024
Reviewer's report:
Which Scoring Systems Are Useful for Predicting the Prognosis of Lower Gastrointestinal
Bleeding? Old and New
The authors conducted a large retrospective study evaluating the performance of scoring
systems in predicting outcomes for patients presenting to the emergency department with
lower gastrointestinal bleeding (LGIB). The inclusion of recently developed scoring systems
(e.g., CHAMPS, SHA2PE) adds value to the study and provides important insights into LGIB
risk stratification. However, there are several issues that should be addressed to improve the
manuscript.
Major concerns
Patient Selection
1. The exclusion of patients without colonoscopic confirmation of LGIB may introduce selection
bias, especially in cases where endoscopy was contraindicated due to poor general conditions.
2. The study includes patients with malignancies but does not provide staging data. Malignancy
stages can significantly impact the mortality rate, which is the primary outcome of the study.
Consider adding this data or discussing its potential impact as a limitation.
3. Please clarify if the exclusion criteria (e.g., upper gastrointestinal bleeding or variceal
bleeding) were consistently and rigorously applied across all cases in the dataset.
Comparison Between Scoring Systems
4. The choice of AUROC as the primary metric for comparison is appropriate. However, please
provide the AUROCs for each scoring system and the p-values comparing the scoring systems
for each outcome. For example, compare AIMS 65 with Oakland for predicting 30-day mortality
(e.g., see Chang A, et al., Clin Endosc. 2021). Consider providing these comparisons in an
additional table or as part of Figures 2 & 3") could be more helpful
Statistical Analysis
5. While the study uses multivariate logistic regression effectively, the Hosmer-Lemeshow test
results and their implications for model fit should be reported in greater detail.
6. Adjustments for potential confounding variables (e.g., anticoagulant use, comorbidities) are
acknowledged, but it would be beneficial to expand on interactions between these factors.
Discussion
7. It would be helpful to discuss why certain scores, such as SHA2PE for prolonged hospital
stays, performed better than others and how this aligns with clinical utility.
8. While the results favor AIMS 65, CHAMPS, and ABC for mortality prediction, the discussion
could benefit from an exploration of why these scores excel despite variations in included
variables. For example, the simplicity of AIMS 65 may enhance its clinical adoption compared
to the complexity of CHAMPS.
Please review this paper.
user
Title: Which scoring systems are useful for predicting the prognosis of lower gastrointestinal
bleeding? Old and New
Version: 2 Date: 08 Dec 2024
Reviewer's report:
Which Scoring Systems Are Useful for Predicting the Prognosis of Lower Gastrointestinal
Bleeding? Old and New
The authors conducted a large retrospective study evaluating the performance of scoring
systems in predicting outcomes for patients presenting to the emergency department with
lower gastrointestinal bleeding (LGIB). The inclusion of recently developed scoring systems
(e.g., CHAMPS, SHA2PE) adds value to the study and provides important insights into LGIB
risk stratification. However, there are several issues that should be addressed to improve the
manuscript.
Major concerns
Patient Selection
1. The exclusion of patients without colonoscopic confirmation of LGIB may introduce selection
bias, especially in cases where endoscopy was contraindicated due to poor general conditions.
2. The study includes patients with malignancies but does not provide staging data. Malignancy
stages can significantly impact the mortality rate, which is the primary outcome of the study.
Consider adding this data or discussing its potential impact as a limitation.
3. Please clarify if the exclusion criteria (e.g., upper gastrointestinal bleeding or variceal
bleeding) were consistently and rigorously applied across all cases in the dataset.
Comparison Between Scoring Systems
4. The choice of AUROC as the primary metric for comparison is appropriate. However, please
provide the AUROCs for each scoring system and the p-values comparing the scoring systems
for each outcome. For example, compare AIMS 65 with Oakland for predicting 30-day mortality
(e.g., see Chang A, et al., Clin Endosc. 2021). Consider providing these comparisons in an
additional table or as part of Figures 2 & 3") could be more helpful
Statistical Analysis
5. While the study uses multivariate logistic regression effectively, the Hosmer-Lemeshow test
results and their implications for model fit should be reported in greater detail.
6. Adjustments for potential confounding variables (e.g., anticoagulant use, comorbidities) are
acknowledged, but it would be beneficial to expand on interactions between these factors.
Discussion
7. It would be helpful to discuss why certain scores, such as SHA2PE for prolonged hospital
stays, performed better than others and how this aligns with clinical utility.
8. While the results favor AIMS 65, CHAMPS, and ABC for mortality prediction, the discussion
could benefit from an exploration of why these scores excel despite variations in included
variables. For example, the simplicity of AIMS 65 may enhance its clinical adoption compared
to the complexity of CHAMPS.
assistant