Upper Gastrointestinal Bleed — Sheffield Score — Clinical Pathway: Emergency Department, ICU and Inpatient

Upper Gastrointestinal Bleed Clinical Pathway — Emergency Department, ICU and Inpatient

Sheffield Score

The Sheffield Score is a proposed scoring system meant to provide clinicians, particularly gastroenterologists, with a framework to help decide if and when endoscopic evaluation and intervention should be performed in a pediatric patient with clinical evidence of an upper gastrointestinal bleed.

Score Components Points
History Significant preexisting condition may include:
  • Liver disease
  • History of varices
  • Coagulopathy
  • Intestinal surgery
  • Peptic ulcer disease
  • Prior GI bleed
 1
Presence of melena 1
History of large amount of hematemesis 1
Clinical Assessment HR > 20 from mean HR for age 1
Prolonged capillary refill 4
Lab Findings Hemoglobin drop of 2 g/dL 3
Management Resuscitation Need for a fluid bolus 3
Need for blood transfusion, Hemoglobin < 8 g/dL 6
Need for other blood transfusion 4

Reference

Acute Upper Gastrointestinal Bleeding in Childhood. Development of the Sheffield Scoring System to Predict Need for Endoscopic Therapy.  

Proposed Risk Stratification Based on Sheffield Score

Severity Total Points  
Critical 17-24
  • Shock present
  • Anemia unresponsive to transfusion
  • Significant large volume hematemesis with high suspicion for variceal bleeding
  • UGI bleed with suspected perforation or acute abdomen
Severe 8-16
  • Significant risk factors present
  • Anemia that responds to transfusion
  • Coagulopathy that responds corrects with vitamin K or FFP
Mild 1-7 No significant risk factors
Non-urgent N/A
  • Scant or trivial blood, suspected Mallory Weiss tear
  • Suspected or confirmed anal fissure
  • Suspected swallowed maternal blood in breastfeeding infant