Title: Comparisons of six endoscopy independent scoring systems for the prediction of clinical
outcomes for elderly and younger patients with upper gastrointestinal bleeding
Version: 1 Date: 30 Jan 2022
Reviewer's report:
Li et al reported on the comparison of the six endoscopy independent scoring systems for the
prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal
bleeding.
The strength of the study was the relative large numbers of participants (>1000).
I have several comments:
Introduction:
1. Although the main objective of the study was to evaluate the effectiveness to predict the
clinical outcomes in elderly and young patients, the strength and utility  of this predictive
score,  as highlighted in several guidelines, is to rule out high risk patients, eg. GBS score of
<=1. This point should be highlighted, either in introduction or discussion/limitation. Guideline
Recommendations From the International Consensus Group: 'Use of prognostic scales and early
discharge of patients at low risk have the potential to reduce the need for endoscopy, hospital
stays, and associated costs without increasing harms. Sensitivity for detecting high-risk patients
is a critical outcome, because it is important to avoid incorrectly classifying high risk as low
risk when making decisions about early discharge. Specificity is less crucial, because low
specificity results in more low-risk patients being hospitalized but not in high-risk patients being
discharged. '
Methodology:
1. Each scoring system could be described in methodology, including the range of scores. Will
be good to show the parameters used in calculating the various risk scores in supplementary
tables. The readers will have a clearer view in seeing the differences between the various score.
2. Please predefined what score of AUROC represent good, fair or poor accuracy.
Results:
1. In table 1,  why the differences in the usage of medications, relevant variables and scores
components and findings at endoscopy were not analysed statistically? No P value
2. Is there any analysis comparing the accuracy between the different risk scores? Although
ABC's AUROC score numerically appeared better in most outcomes, if there is analysis
comparing different scoring system will be even more convincing.
Discussion:
1. Limitations of the study were not discussed - e.g.. retrospective nature of the study, the
analysis to rule out high risk patients was not done,  other important parameters, including
rehospitalisation and prolonged hospitalisation were not analysed.
Title: Comparisons of six endoscopy independent scoring systems for the prediction of clinical
outcomes for elderly and younger patients with upper gastrointestinal bleeding
Version: 1 Date: 30 Jan 2022
Reviewer's report:
Li et al reported on the comparison of the six endoscopy independent scoring systems for the
prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal
bleeding.
The strength of the study was the relative large numbers of participants (>1000).
I have several comments:
Introduction:
1. Although the main objective of the study was to evaluate the effectiveness to predict the
clinical outcomes in elderly and young patients, the strength and utility  of this predictive
score,  as highlighted in several guidelines, is to rule out high risk patients, eg. GBS score of
<=1. This point should be highlighted, either in introduction or discussion/limitation. Guideline
Recommendations From the International Consensus Group: 'Use of prognostic scales and early
discharge of patients at low risk have the potential to reduce the need for endoscopy, hospital
stays, and associated costs without increasing harms. Sensitivity for detecting high-risk patients
is a critical outcome, because it is important to avoid incorrectly classifying high risk as low
risk when making decisions about early discharge. Specificity is less crucial, because low
specificity results in more low-risk patients being hospitalized but not in high-risk patients being
discharged. '
Methodology:
1. Each scoring system could be described in methodology, including the range of scores. Will
be good to show the parameters used in calculating the various risk scores in supplementary
tables. The readers will have a clearer view in seeing the differences between the various score.
2. Please predefined what score of AUROC represent good, fair or poor accuracy.
Results:
1. In table 1,  why the differences in the usage of medications, relevant variables and scores
components and findings at endoscopy were not analysed statistically? No P value
2. Is there any analysis comparing the accuracy between the different risk scores? Although
ABC's AUROC score numerically appeared better in most outcomes, if there is analysis
comparing different scoring system will be even more convincing.
Discussion:
1. Limitations of the study were not discussed - e.g.. retrospective nature of the study, the
analysis to rule out high risk patients was not done,  other important parameters, including
rehospitalisation and prolonged hospitalisation were not analysed.
Please review this paper.
user
Title: Comparisons of six endoscopy independent scoring systems for the prediction of clinical
outcomes for elderly and younger patients with upper gastrointestinal bleeding
Version: 1 Date: 30 Jan 2022
Reviewer's report:
Li et al reported on the comparison of the six endoscopy independent scoring systems for the
prediction of clinical outcomes for elderly and younger patients with upper gastrointestinal
bleeding.
The strength of the study was the relative large numbers of participants (>1000).
I have several comments:
Introduction:
1. Although the main objective of the study was to evaluate the effectiveness to predict the
clinical outcomes in elderly and young patients, the strength and utility  of this predictive
score,  as highlighted in several guidelines, is to rule out high risk patients, eg. GBS score of
<=1. This point should be highlighted, either in introduction or discussion/limitation. Guideline
Recommendations From the International Consensus Group: 'Use of prognostic scales and early
discharge of patients at low risk have the potential to reduce the need for endoscopy, hospital
stays, and associated costs without increasing harms. Sensitivity for detecting high-risk patients
is a critical outcome, because it is important to avoid incorrectly classifying high risk as low
risk when making decisions about early discharge. Specificity is less crucial, because low
specificity results in more low-risk patients being hospitalized but not in high-risk patients being
discharged. '
Methodology:
1. Each scoring system could be described in methodology, including the range of scores. Will
be good to show the parameters used in calculating the various risk scores in supplementary
tables. The readers will have a clearer view in seeing the differences between the various score.
2. Please predefined what score of AUROC represent good, fair or poor accuracy.
Results:
1. In table 1,  why the differences in the usage of medications, relevant variables and scores
components and findings at endoscopy were not analysed statistically? No P value
2. Is there any analysis comparing the accuracy between the different risk scores? Although
ABC's AUROC score numerically appeared better in most outcomes, if there is analysis
comparing different scoring system will be even more convincing.
Discussion:
1. Limitations of the study were not discussed - e.g.. retrospective nature of the study, the
analysis to rule out high risk patients was not done,  other important parameters, including
rehospitalisation and prolonged hospitalisation were not analysed.
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