JournalFeed PubMetric Report
Analysis Source: PDF full text + PubMed metadata
JournalFeed PubMetric Score
High Confidence
PubMetric Score Breakdown
Study addresses a common emergency condition with potential practice-changing implications.
Prospective observational study with appropriate statistical analysis.
Some concerns due to single-center design and exclusion criteria.
Statistically significant and clinically meaningful results.
First study of its kind; requires further validation.
Scoring systems are easily implemented in ED settings.
Funding present; COI disclosure present.
Critical Appraisal
Study Identification
Background
Study Question
Study Design & Conduct
Prospective / Retrospective: Prospective
Multicenter: No
Unit of Allocation: Not applicable
Unit of Analysis: Patients
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: In-hospital
Population
- Adult patients (≥18 years)
- Clinically confirmed upper gastrointestinal bleeding
- Age under 18 years
- Pregnancy
- Diagnosis of lower gastrointestinal bleeding
- Incomplete or missing medical records
- Refusal to participate
Number Enrolled: 178
Number Analyzed: 178
Key Baseline Characteristics
Sex: 61.8% male
Disease Severity: Not reported
Care Setting Distribution: Emergency department
Additional Baseline Characteristics
- Higher respiratory rates and lower oxygen saturation in non-survivors
- Comorbidities like CHF and malignancy more frequent in non-survivors
Exposures / Interventions
Description: Calculation of NEWS-2 and NEWS2-L scores
Definition / Dose: Not applicable
Timing: At presentation
Classification Method: Protocolized
Protocolized / Discretionary: Protocolized
Description: Conventional scoring systems (AIMS65, GBS, PERS)
Definition: Standard definitions as per original scoring systems
Outcomes & Results
Primary Outcomes
Definition: Accuracy of scoring systems in predicting mortality
Time Point: In-hospital
Measurement Method: ROC curve analysis
Results: AIMS65 sensitivity 83.3%, NEWS-2 specificity 82.0%, NEWS2-L AUC 0.772
Secondary Outcomes
Definition: Not applicable
Time Point: Not applicable
Measurement Method: Not applicable
Results: Not applicable
Risk of Bias
Risk of Bias - ROBINS-I
- Confounding (Some concerns): Potential confounders like comorbidities were considered, but single-center design limits generalizability.
- Selection of Participants (Low): Clear inclusion and exclusion criteria were applied.
- Classification of Interventions (Low): Interventions (scoring systems) were clearly defined and applied consistently.
- Deviations from Intended Interventions (Low): No deviations reported; scoring was protocolized.
- Missing Data (Some concerns): Exclusion of patients with missing data could introduce bias.
- Measurement of Outcomes (Low): Mortality was objectively measured.
- Selection of the Reported Result (Low): All relevant outcomes were reported.
Transparency
COI Statement Present: TRUE
PubMetric Brief
Take-Home Message
NEWS-2 and AIMS65 are effective for predicting mortality in UGIB patients, with NEWS2-L offering minimal additional benefit.
Study Summary
This prospective observational study compared the prognostic performance of NEWS-2 and its lactate-enhanced version (NEWS2-L) with conventional scoring systems like AIMS65, Glasgow-Blatchford Score (GBS), and pre-endoscopic Rockall Score (PERS) in predicting in-hospital mortality among 178 ED patients with upper gastrointestinal bleeding (UGIB). Mortality occurred in 20.2% of patients. AIMS65 had the highest sensitivity, while NEWS-2 showed the highest specificity. NEWS2-L offered minimal improvement over NEWS-2. Multivariate analysis confirmed AIMS65 and NEWS-2 as independent mortality predictors, but not lactate alone.
Citation
Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional risk scores
. The American journal of emergency medicine. 2026;101:14-21. PMID: 41448104