Development of a scoring system to predict a positive diagnosis on video capsule endoscopy for suspected small bowel bleeding.

ABSTRACT Background In stable patients, video capsule endoscopy (VCE) is the recommended first test for patients presenting with suspected small bowel bleeding (SSB). The aim of this study is to develop a scoring system to aid clinicians in deciding which patients with SSB would benefit from VCE. Methods A multicenter database of patients who underwent VCE for SSB was created. A multivariable logistic regression analysis was utilized on a developmental cohort to determine independent predictors of a positive diagnosis on VCE and develop the scoring system. Receiver operating characteristic analysis compared the performance of the scoring system between the developmental cohort and the validation cohort. Results 314 patients underwent VCE for SSB. Multivariable analysis revealed three variables – age less than 54 years old (OR 0.25, 95% CI 0.11–0.58), inpatient status with overt bleeding (OR 2.38, 95% CI 1.05–5.39), and hemoglobin less than 6.4 g/dL (OR 2.68, 95% CI 1.11–6.48) as independent predictors of a diagnosis on VCE. The performance of the scoring system in the developmental cohort (C-statistic 0.70; 95% CI 0.62–0.77) and the validation cohort (C-statistic 0.69; 95% CI 0.61–0.75) was not significantly different (p = 0.91). Conclusions For patients with suspected small bowel bleeding, age older than 54 years, hemoglobin