1
|
Quitadamo P, Anselmi F, Mantegazza C, Tambucci R, Campanozzi A, Malamisura M, Raucci U, Tipo V, Dolce P, Saccomani MD, Chiaro A, Mancini V, Felici E, Orizio P, Parma B, Salvatore S, Borrelli O. Hematemesis in Infants: The First Evidence-Based Score to Predict the Need for Timely Endoscopy. Pediatr Emerg Care 2022; 38:e1245-e1250. [PMID: 35482500 DOI: 10.1097/pec.0000000000002579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Infantile acute upper gastrointestinal bleeding involves a decision for therapeutic intervention that most pediatricians first coming into contact with the patient are, not unreasonably, unable to objectively provide. Therefore, some objective tools of individual risk assessment would seem to be crucial. The principal aim of the present study was to investigate the anamnestic and clinical parameters of infants with hematemesis, together with laboratory and instrumental findings, to create a scoring system that may help identify those infants requiring an appropriate and timely application of upper gastrointestinal (GI) endoscopy. METHODS Clinical data of infants admitted for hematemesis to the participating centers over the study period were systematically collected. According to the outcome dealing with rebleeding, need for blood transfusion, mortality, finding of GI bleeding lesions, or need for surgical intervention, patients were blindly divided into a group with major clinical severity and a group with minor clinical severity. Univariate and multivariate logistic regressions were conducted to investigate significant prognostic factors for clinical severity. RESULTS According to our findings, we drafted a practical diagnostic algorithm and a clinical score able to predict the need for timely upper GI endoscopy (BLOVO infant score). Our clinical scoring system was created by incorporating anamnestic factors, clinical parameters, and laboratory findings that emerged as predictors of a worst outcome. CONCLUSIONS We provided the first objective tool of individual risk assessment for infants with hematemesis, which could be very useful for pediatricians first coming into contact with the patient in the emergency department.
Collapse
Affiliation(s)
- Paolo Quitadamo
- From the Department of Pediatrics, Santobono-Pausilipon Children's Hospital
| | - Federica Anselmi
- Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples
| | - Cecilia Mantegazza
- Department of Pediatrics, University of Milan, Buzzi Children's Hospital, Milan
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, University Hospital of Foggia, Foggia
| | - Monica Malamisura
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Vincenzo Tipo
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples
| | | | - Andrea Chiaro
- Paediatric Gastroenterology and Digestive Endoscopy Unit, Giannina Gaslini Institute, Genoa
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, San Carlo Borromeo Hospital, Milan
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia
| | - Barbara Parma
- Paediatric Department, ASST-Lariana, Sant'Anna General Hospital, Como
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte," University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| |
Collapse
|