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This retrospective cohort study developed a simple clinical scoring model and a management algorithm to prognosticate patients at risk of severe LGIB. Severe LGIB was defined by transfusion needs and clinical course, predictors were identified via multivariate logistic regression, and an objective triage-based pathway was proposed.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/lower-gastro-intestinal-bleeding-lgib-predictive-model-and-management-algorithm/502954/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/lower-gastro-intestinal-bleeding-lgib-predictive-model-and-management-algorithm/502954.png","ImageObject",300,407,{"name":92,"@type":93},"Chumphorn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-24","2026-10-03",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What problem does the study address for severe LGIB?","Question",{"text":112,"@type":113},"Early diagnosis and management of severe LGIB are challenging, and few clinical predictive tools exist and none had been validated in Asian populations.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was severe LGIB defined in this study?",{"text":117,"@type":113},"Severe LGIB was modified from Strate’s definition, including bleeding requiring multiple units of packed red blood cells within 24 hours, re-bleeding after 24 hours of stability, and/or need for additional transfusion beyond 24 hours.",{"name":119,"@type":110,"acceptedAnswer":120},"Which variables were included in the LGIB risk stratification model?",{"text":121,"@type":113},"The model included tachycardia, hypotension, anemia, metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},502954,1791701530,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","􀂦   \nSingapore General Hospital [https://orcid.org/0000-0003-0928-257X](https://orcid.org/0000-0003-0928-257X)  \nSingapore General Hospital  \nSingapore General Hospital  \nSingHealth Duke-NUS Academic Medical Centre  \nSingapore General Hospital  \nSingapore General Hospital  \nLower gastrointestinal bleeding, predictive model  August 9th, 2021  \n [https://doi.org/10.21203/rs.3.rs-768939/v1](https://doi.org/10.21203/rs.3.rs-768939/v1)  \n 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License.  \nRead Full License  \n A version of this preprint was published at World Journal of Emergency Surgery on November 22nd, 2021 . See the published version at [https://doi.org/10.1186/s13017-021-00402-y](https://doi.org/10.1186/s13017-021-00402-y).  \nLower Gastro-Intestinal Bleeding (LGIB) is a common presentation of surgical admissions, imposing a signi¦cant burden on healthcare costs and resources. There is a paucity of standardised clinical predictive tools available for the initial assessment and risk strati¦cation of patients with LGIB. We propose a simple clinical scoring model to prognosticate patients at risk of severe LGIB and an algorithm to guide management of such patients.  \n A retrospective cohort study was conducted, identifying consecutive patients admitted to our institution for LGIB over a 1-year period. Baseline demographics, clinical parameters at initial presentation and treatment interventions were recorded. Severe LGIB was the primary outcome measure. Multivariate logistic regression was performed to identify factors predictive of severe LGIB. A clinical management algorithm was developed to discriminate between patients requiring admission, and to guide endoscopic, angiographic and/or surgical intervention.  \n 226/649 (34.8%) patients had severe LGIB. Six variables were entered into a clinical predictive model for risk strati¦cation of LGIB: Tachycardia (HR>100), hypotension (SBP\u003C90mmHg), anemia (Hb\u003C9g/dL), metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding. The optimum cut-off score of >1 had a sensitivity of 91.9%, speci¦city of 39.8%, and Positive and Negative Predictive Values of 45% and 90.2% respectively for predicting severe LGIB. The Area Under Curve (AUC) was 0.77. B  \n Early diagnosis and management of severe LGIB remains a challenge for the acute care surgeon. The predictive model described comprises objective clinical parameters routinely obtained at initial triage to guide risk strati¦cation, disposition and inpatient management of patients.  \nLower Gastrointestinal Bleeding (LGIB), de¦ ned as bleeding distal to the ligament of Treitz, remains a common presenting symptom for emergency general surgical patients. The annual incidence (20–30 cases per 100,000 adults) rises 200-fold between the 3rd and 9th decade of life. (1, 2) Amongst the elderly, the morbidity secondary to LGIB is exacerbated due to the interplay of multiple comorbidities, use of antiplatelet and/or anticoagulants and poor functional reserves. (3)  \nThe complexity in management of patients with LGIB relates to the wide spectrum of aetiologies, spanning benign and malignant disease, affecting the small and large intestine as well as anal canal. The presentation varies widely between stable hemorrhoidal bleeding requiring outpatient management to exsanguinating colonic bleeding that may require a colectomy. For these presentations and everything in between, a well-developed diagnostic, investigative and therapeutic strategy is required to resuscitate, local ise and then treat the underlying pathology. As there is no ‘one size ¦ts all’, LGIB management remains di¨ cult to protocol ise.  \nTimely recognition of severe LGIB is crucial in implementing effective management pathways. However, few clinical predictive tools for prognostication of LGIB exist in the literature. Furthermore, none have been validated in Asian populations. (4) In this study, we aim to identify predictors of","cbCaioOofX4ssDVC","https://ap.wps.com/l/cbCaioOofX4ssDVC","pdf",458818,22,"English","# Background and Rationale\n# Study Aim and Objectives\n# Methods and Patient Selection\n## Definition of LGIB and Severe LGIB\n# Statistical Analysis and Predictive Model Development\n# Results and Diagnostic Performance\n# Clinical Implications","[{\"question\":\"What problem does the study address for severe LGIB?\",\"answer\":\"Early diagnosis and management of severe LGIB are challenging, and few clinical predictive tools exist and none had been validated in Asian populations.\"},{\"question\":\"How was severe LGIB defined in this study?\",\"answer\":\"Severe LGIB was modified from Strate’s definition, including bleeding requiring multiple units of packed red blood cells within 24 hours, re-bleeding after 24 hours of stability, and/or need for additional transfusion beyond 24 hours.\"},{\"question\":\"Which variables were included in the LGIB risk stratification model?\",\"answer\":\"The model included tachycardia, hypotension, anemia, metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding.\"}]","Lower Gastro-Intestinal Bleeding (LGIB) - Predictive Model and Management Algorithm | PDF",1791046932,55]