Introduction: Gross Hematuria (GH) is a common presenting complaint to the Emergency Department (ED). Some patients develop hematuria that is severe enough to warrant admission, continuous bladder irrigation (CBI), blood transfusions and operative interventions. This study aims to describe the demographics and risk factors of patients that require admission to the hospital for urologic care and develop a novel scoring system to guide clinical decisions.

Methods: All patients who presented to the ED with GH at a single institution between 2018 and 2022 were reviewed. Patient demographics, co-morbidities, relevant urologic history and outcomes were recorded. Descriptive statistics were performed. A split-sample based method was employed with a derivation and validation cohort reviewed separately. Univariate and multivariate analysis (MVA) were conducted to identify variables correlating with the need for admission. Using the Johnson’s scoring method, variables that correlated on the MVA were used to develop the scoring system that was then validated on another cohort of patients presenting with GH.

Results: Of 1,012 patients included in the final analysis of the derivation group, 229 (23%) were admitted. Heart rate >100 beats/minute at presentation, need for CBI, history of urologic malignancy, urologic consultation requested and need for blood transfusions of ≥2 units were variables found to be predictive of need for admission when developing the scoring system. The scoring system had an area under the curve (AUC) of 0.917 on the Receiver-Operator Curve (ROC). By selecting a cut-off score of ≥10 points, a sensitivity of 84% and a specificity of 86% were achieved. This scoring system was validated on a separate validation cohort of 311 patients. The analysis yielded a similar sensitivity and specificity with AUC of 0.936 on the ROC.

Conclusion: In the present study, we present a novel, practical and internally validated scoring system to predict patients at risk of requiring hospital admission for GH presenting to the ED. Our proposed scoring system may be helpful in triaging patients and planning hospital bed management. Prospective external validation of this scoring system at both academic and community hospitals is warranted.