Title: Safe discharge for patients admitted for lower gastrointestinal bleeding (LGITB):
derivation and validation of a novel scoring system
Version: 1 Date: 24 Jul 2023
Reviewer's report:
I have read with interest the paper by Yue Zhao et al.
Aim of the study is to identify a new clinical score to guide "safe discharge" in patients with
lower gastrointestinal bleeding.
Authors drew a new score in the derivation phase of the study (retrospective analysis of patients
admitted in three years in a surgical unit of a single center) and then validated the score in a
population of patients prospectively enrolled. Also patients from the second part of the study
were patients admitted in the same surgical unit.
Authors found that the new score outperformed the Glasgow Blatchford score and performed
similarly to the Oakland score, and found that a larger proportion of patients were categorized
as low risk with the new score compared to the Oakland score.
Even if the aim of the study is of great interest, I am afraid that the study design is not adequate
to design a new clinical score for safe discharge in patients with LGIB.
All the patients included into the study were already admitted to a surgical department from an
Emergency department (ED).
This has two implications:
First of all, some patients presenting to the ED for LGIB could have died before admission to
the surgical guard, either in the ED itself or in the Intensive care unit. Considering that a similar
score should be used to avoid any possible death, excluding these patients from the analysis
would introduce a strong bias
Secondly, we cannot evaluate the usefulness of this score in guiding safe discharge from the ED,
without admitting the patient (that is the main aim of clinical scores for patients with bleeding).
This also means that you can't really compare this new score to the Oakland score
I don't think that a similar score could also be somehow useful in clinical practice to discharge
patients once they have been admitted into the hospital. Once a patient is admitted, in fact, we
cannot rely on parameters at admission (such as Hb or systemic pressure) to decide for discharge
but we need to evaluate the present status of the patient.
Morevoer, once a patient is admitted for lower gastrointestinal bleeding, endoscopy should be
performed during the index admission, even if not urgently. In this case only 60% of patients
underwent colonoscopy.
Title: Safe discharge for patients admitted for lower gastrointestinal bleeding (LGITB):
derivation and validation of a novel scoring system
Version: 1 Date: 24 Jul 2023
Reviewer's report:
I have read with interest the paper by Yue Zhao et al.
Aim of the study is to identify a new clinical score to guide "safe discharge" in patients with
lower gastrointestinal bleeding.
Authors drew a new score in the derivation phase of the study (retrospective analysis of patients
admitted in three years in a surgical unit of a single center) and then validated the score in a
population of patients prospectively enrolled. Also patients from the second part of the study
were patients admitted in the same surgical unit.
Authors found that the new score outperformed the Glasgow Blatchford score and performed
similarly to the Oakland score, and found that a larger proportion of patients were categorized
as low risk with the new score compared to the Oakland score.
Even if the aim of the study is of great interest, I am afraid that the study design is not adequate
to design a new clinical score for safe discharge in patients with LGIB.
All the patients included into the study were already admitted to a surgical department from an
Emergency department (ED).
This has two implications:
First of all, some patients presenting to the ED for LGIB could have died before admission to
the surgical guard, either in the ED itself or in the Intensive care unit. Considering that a similar
score should be used to avoid any possible death, excluding these patients from the analysis
would introduce a strong bias
Secondly, we cannot evaluate the usefulness of this score in guiding safe discharge from the ED,
without admitting the patient (that is the main aim of clinical scores for patients with bleeding).
This also means that you can't really compare this new score to the Oakland score
I don't think that a similar score could also be somehow useful in clinical practice to discharge
patients once they have been admitted into the hospital. Once a patient is admitted, in fact, we
cannot rely on parameters at admission (such as Hb or systemic pressure) to decide for discharge
but we need to evaluate the present status of the patient.
Morevoer, once a patient is admitted for lower gastrointestinal bleeding, endoscopy should be
performed during the index admission, even if not urgently. In this case only 60% of patients
underwent colonoscopy.
Please review this paper.
user
Title: Safe discharge for patients admitted for lower gastrointestinal bleeding (LGITB):
derivation and validation of a novel scoring system
Version: 1 Date: 24 Jul 2023
Reviewer's report:
I have read with interest the paper by Yue Zhao et al.
Aim of the study is to identify a new clinical score to guide "safe discharge" in patients with
lower gastrointestinal bleeding.
Authors drew a new score in the derivation phase of the study (retrospective analysis of patients
admitted in three years in a surgical unit of a single center) and then validated the score in a
population of patients prospectively enrolled. Also patients from the second part of the study
were patients admitted in the same surgical unit.
Authors found that the new score outperformed the Glasgow Blatchford score and performed
similarly to the Oakland score, and found that a larger proportion of patients were categorized
as low risk with the new score compared to the Oakland score.
Even if the aim of the study is of great interest, I am afraid that the study design is not adequate
to design a new clinical score for safe discharge in patients with LGIB.
All the patients included into the study were already admitted to a surgical department from an
Emergency department (ED).
This has two implications:
First of all, some patients presenting to the ED for LGIB could have died before admission to
the surgical guard, either in the ED itself or in the Intensive care unit. Considering that a similar
score should be used to avoid any possible death, excluding these patients from the analysis
would introduce a strong bias
Secondly, we cannot evaluate the usefulness of this score in guiding safe discharge from the ED,
without admitting the patient (that is the main aim of clinical scores for patients with bleeding).
This also means that you can't really compare this new score to the Oakland score
I don't think that a similar score could also be somehow useful in clinical practice to discharge
patients once they have been admitted into the hospital. Once a patient is admitted, in fact, we
cannot rely on parameters at admission (such as Hb or systemic pressure) to decide for discharge
but we need to evaluate the present status of the patient.
Morevoer, once a patient is admitted for lower gastrointestinal bleeding, endoscopy should be
performed during the index admission, even if not urgently. In this case only 60% of patients
underwent colonoscopy.
assistant