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Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study.

Journal Club Summary

Methodology Score: 4/5                   
Usefulness Score: 4/5
Stanley AJ, et al.
BMJ. 2017 Jan 4;356:i6432.
This multicentre, multinational study assessed the ability of five upper gastrointestinal bleeding scores to predict outcomes including death, re-bleeding, need for endoscopy, transfusion, surgery or interventional radiology, and length of hospital stay, finding that the Glasgow Blatchford score is best at predicting the composite outcome of intervention or death, although AIMS65 was best at predicting mortality. While applying the scores as recommended may result in missing a small number of significant outcomes, they are easy to apply and can help expedite disposition planning, whether outpatient management or hospital-based intervention.
By: Dr. Daniel James

Epi lesson

Composite Outcomes                                              

It is not unusual for studies to select a composite outcome as their primary outcome measure. The necessity to do so is often justified by the rare occurrence of the primary outcome of true interest (for e.g. death or survival), and by the otherwise very large sample size required to measure it. Caveats to using composite outcomes include the inability to attribute associated risk or benefit of the intervention with the main (rare) outcome of interest itself. Similarly, it is possible to erroneously conclude to the benefit of an intervention where such benefit may only be true for “surrogate” components of the composite outcomes and not the main outcome of interest.
By: Dr. Christian Vaillancourt

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