An External Validation Study of the Oakland and Glasgow-Blatchford Scores for Predicting Adverse Outcomes of Acute Lower Gastrointestinal Bleeding in an Asian Population

Abstract

Aims. This study is aimed at (1) validating the performance of Oakland and Glasgow-Blatchford (GBS) scores and (2) comparing these scores with the SALGIB score in predicting adverse outcomes of acute lower gastrointestinal bleeding (ALGIB) in a Vietnamese population. Methods. A multicenter cohort study was conducted on ALGIB patients admitted to seven hospitals across Vietnam. The adverse outcomes of ALGIB consisted of blood transfusion; endoscopic, radiologic, or surgical interventions; severe bleeding; and in-hospital death. The Oakland and GBS scores were calculated, and their performance was compared with that of SALGIB, a locally developed prediction score for adverse outcomes of ALGIB in Vietnamese, based on the data at admission. The accuracy of these scores was measured using the area under the receiver operating characteristic curve (AUC) and compared by the chi-squared test. Results. There were 414 patients with a median age of 60 (48–71). The rates of blood transfusion, hemostatic intervention, severe bleeding, and in-hospital death were 26.8%, 15.2%, 16.4, and 1.4%, respectively. The SALGIB score had comparable performance with the Oakland score (AUC: 0.81 and 0.81, respectively; p = 0.631 ) and outperformed the GBS score (AUC: 0.81 and 0.76, respectively; p = 0.002 ) for predicting the presence of any adverse outcomes of ALGIB. All of the three scores had acceptable and comparable performance for in-hospital death but poor performance for hemostatic intervention. The Oakland score had the best performance for predicting severe bleeding. Conclusions. The Oakland and SALGIB scores had excellent and comparable performance and outperformed the GBS score for predicting adverse outcomes of ALGIB in Vietnamese.

External validation of the Oakland score to assess safe hospital discharge among adult patients with acute lower gastrointestinal bleeding in an accident and emergency department in Hong Kong

“…The AUC of 0.88 in the present study is in accordance with the AUC in previous external validation studies 8,12 . This shows that the Oakland score can perform equally well in Hong Kong in identifying LGIB patients who are at low risk of adverse outcomes.…”

“…The AUC of 0.88 in the present study is in accordance with the AUC in previous external validation studies. 8,12 This shows that the Oakland score can perform equally well in Hong Kong in identifying LGIB patients who are at low risk of adverse outcomes. Determining the cutoff score for safe discharge requires balancing the risk of patient misclassification with the need to include a greater proportion of low-risk patients for the score to be useful clinically.…”

“…To the best of the author’s knowledge, this study is the first Oakland score validation study in a Chinese population. The Oakland score was previously validated in the United Kingdom, 7 the United States 8 and Vietnam, 12 and it was shown that the score can perform well in predicting safe discharge.…”

Comparison of scoring systems for predicting clinical outcomes of acute lower gastrointestinal bleeding: A prospective cohort study

“…10 Recently, in a study of 414 patients hospitalized with LGIB, it was found that GBS precisely predicted adverse outcomes in ALGIB. 29 Our study underscores the ability of GBS to identify LGIB patients at risk of severe bleeding, blood transfusion requirement, and in-hospital mortality. However, AIMS65 score did not achieve acceptable performance in predicting all outcomes.…”

“…28 A multicenter retrospective cohort study reported that the Oakland score had excellent performance in predicting adverse outcomes. 29 A meta-analysis of LGIB risk prognostication models revealed that the Oakland score had the most discriminative performance in predicting the need for blood transfusion and major bleeding. Although AIMS65 score and GBS were designed for UGIB, 31,32 they include information on factors affecting LGIB progression 15,16 ; these scores may also effectively stratify LGIB risks.…”