Lower Gastrointestinal Bleeding Clinical Trial
Official title:
External Validation of a Prognostic Risk Score for Safe Discharge Among Patients With Lower Gastrointestinal Bleeding: A Prospective Multi-centre Cohort Study
NCT number | NCT03935360 |
Other study ID # | 113116 |
Secondary ID | |
Status | Completed |
Phase | |
First received | |
Last updated | |
Start date | November 25, 2019 |
Est. completion date | March 2, 2024 |
Verified date | March 2024 |
Source | Lawson Health Research Institute |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Lower gastrointestinal bleeding (LGIB) is a common presentation in the Emergency Room. It can deteriorate into severe adverse event. However some are discharged before these events occur. The Oakland-Jairath score was developed to help determine which patients can be safely discharged and which should be admitted from the ER to the hospital. The score did well in its development, but now needs to be externally validated by other independent cohorts. The limitations of the first study will be addressed in our study. The goal of this study is to perform the first prospective, multi-centered, external validation of the Oakland-Jairath risk score on an independent and diverse population who present to the emergency room with LGIB.
Status | Completed |
Enrollment | 344 |
Est. completion date | March 2, 2024 |
Est. primary completion date | March 2, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. Presenting complaint of LGIB, defined as any of the following: 1. Bright red blood per rectum 2. Maroon coloured stool 3. Criteria A and B applies regardless if the blood is seen without stool, with stool of any consistency, or only on the toilet paper Exclusion Criteria: 1. Age = 18 2. Hematemesis, defined as bright blood or coffee ground emesis 3. Patients who developed LGIB while already admitted to hospital for any reason 4. Patients transferred between hospitals 5. Failure to obtain informed consent 6. Occult bleeding, defined as the presence of a positive FOBT/FIT or iron deficiency anemia in the absence of bright red blood per rectum or maroon coloured stool 7. Perceived inability to contact the subject by telephone or e-mail for the 28 day follow up assessment |
Country | Name | City | State |
---|---|---|---|
Canada | University of Alberta Hospital | Edmonton | Alberta |
Canada | Nova Scotia Health - Victoria General Site | Halifax | Nova Scotia |
Canada | London Health Sciences Centre | London | Ontario |
Canada | McGill University Health Centre | Montreal | Quebec |
Canada | Centre hospitalier de l'Université de Montréal (CHUM) | Montréal | Quebec |
Canada | Health Science Centre | Winnipeg | Manitoba |
Lead Sponsor | Collaborator |
---|---|
Lawson Health Research Institute | McGill University, Université de Montréal, University of Alberta, University of Oxford, Western University, Canada |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Discrimination of the Oakland-Jairath score for predicting safe discharge | Discrimination, defined as the ability of the prediction model to differentiate between those who develop and do not develop the outcome event of interest, as measured by the c-statistic, and calibration, defined as the agreement between predicted and observed outcomes, measured by a calibration plot, of the Oakland-Jairath score for predicting safe discharge, defined as the absence of ALL of the following:
i. Rebleeding, defined as [additional blood transfusions] or [a further decrease in hematocrit concentration of 20% or more], both after 24h clinical stability ii. Readmission for LGIB within 28 days iii. Red blood cell transfusion iv. Therapeutic intervention for hemostasis (endoscopic/IR/surgery) v. Death within 28 days |
28 days after enrollment | |
Secondary | Discrimination of the Oakland-Jairath score compared to pre-existing LGIB risk scores | Measured by the c-statistic and compared using the DeLong test The scale is Oakland & Jairath score for the prediction of safe discharge after LGIB. There are seven variables that are scored. Having a lower score in all variables and overall represents a better outcome for a safe discharge after LGIB.
Age: <40 = 0; 40-69 =1; =70 =2 Sex: F = 0; M =1 Previous LGIB admission: No = 0; Yes = 1 DRE findings: No blood = 0; Blood = 1 Heart rate (bpm): =70 = 0; 70-89= 1; 90-109= 2; =110 = 3 Systolic blood pressure (mmHg): 50-89 = 5; 90-119 = 4; 120-129 = 3; 130-159 = 2; =160 = 0 Hemoglobin (g/dL): 36-69 = 22; 70-89 = 17; 90-109 = 13; 110-129 = 8; 130-159 = 4; =160 = 0 Total with variables added together that translates to the probability of safe discharge: 0-2 = 0.99; 3 = 0.98; 4 = 0.97; 5-7 = 0.96; 8 = 0.95; 9 = 0.93; 10 = 0.91; 11 = 0.89; 12-13 = 0.87-0.89; 14-15 = 0.77-0.81; 16-17 = 0.67-0.72; 18-20 = 0.50-0.62; 21-23 = 0.33-0.45; 24-26 = 0.20-0.28; 27-29 = 0.11-0.16; =30 = <0.1 |
28 days after enrollment | |
Secondary | Discrimination of the Oakland-Jairath score compared to traditional UGIB risk scores | Measured by the c-statistic and compared using the DeLong test The scale is Oakland & Jairath score for the prediction of safe discharge after LGIB. There are seven variables that are scored. Having a lower score in all variables and overall represents a better outcome for a safe discharge after LGIB.
Age: <40 = 0; 40-69 =1; =70 =2 Sex: F = 0; M =1 Previous LGIB admission: No = 0; Yes = 1 DRE findings: No blood = 0; Blood = 1 Heart rate (bpm): =70 = 0; 70-89= 1; 90-109= 2; =110 = 3 Systolic blood pressure (mmHg): 50-89 = 5; 90-119 = 4; 120-129 = 3; 130-159 = 2; =160 = 0 Hemoglobin (g/dL): 36-69 = 22; 70-89 = 17; 90-109 = 13; 110-129 = 8; 130-159 = 4; =160 = 0 Total with variables added together that translates to the probability of safe discharge: 0-2 = 0.99; 3 = 0.98; 4 = 0.97; 5-7 = 0.96; 8 = 0.95; 9 = 0.93; 10 = 0.91; 11 = 0.89; 12-13 = 0.87-0.89; 14-15 = 0.77-0.81; 16-17 = 0.67-0.72; 18-20 = 0.50-0.62; 21-23 = 0.33-0.45; 24-26 = 0.20-0.28; 27-29 = 0.11-0.16; =30 = <0.1 |
28 days after enrollment |
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