The Sheffield Scoring System: An 8-Year Descriptive Cohort Analysis of a Tool for Predicting the Need for Endoscopic Hemostatic Intervention in Pediatric Patients with Upper Gastrointestinal Bleeding at a Tertiary Hospital in Khon Kaen, Thailand.

Abstract

Purpose: Upper gastrointestinal bleeding (UGIB) is life-threatening, and the gold standard for diagnosis and treatment is endoscopy, which is relatively invasive. Our purpose was to predict the need for endoscopy among children with UGIB using the Sheffield scoring system, characterize clinical and endoscopic findings among children with UGIB, and determine the predictive value of the Sheffield scoring system for endotherapeutic intervention.

Methods: This descriptive cohort study included 28 children aged 0-18 years who presented with UGIB between 2017 and 2024 and were assessed using the Sheffield scoring system. Clinical and endoscopic data were analyzed.

Results: Among the 28 children, 21 (75.0%) and 7 (25.0%) respectively scored >8 (group 1) and <8 (group 2) in the Sheffield system. Endoscopic hemostasis was required for 22 (78.6%) patients, of whom 95.5% were in group 1. One child in Group 2 who underwent endoscopy had a vascular malformation with prior bleeding. The most prevalent underlying disease was portal hypertension (85.7%). The most significant endoscopic finding was esophageal varices (71.4%). The positive and negative predictive values were respectively 100.0% (95% confidence interval [CI], 83.9-100.0%) and 85.7% (95% CI, 42.1-99.6%). The sensitivity and specificity were respectively, 95.5% (95% CI, 77.2-99.9%) and 100.0% (95% CI, 54.1-100.0%).

Conclusion: The Sheffield scoring system might be a useful tool for predicting the need for endoscopic hemostasis among children with UGIB. However, larger prospective studies are required for validation.