Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study

Abstract

Bowel Disease Research Foundation and National Health Service Blood and Transplant.

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

“…It is the first score that has been specifically designed for LGIB and externally validated 22. It comprises seven variables that are routinely measured during initial clinical assessment: age, gender, previous hospital admission with LGIB, digital rectal examination findings, heart rate, systolic blood pressure and haemoglobin (Hb, table 1).…”

“…If there are no other indications for hospital admission, a patient scoring ≤8 points can be discharged from the emergency department with outpatient follow-up. Safe discharge is characterised as the absence of all of the following: rebleeding, RBC transfusion, therapeutic intervention to control bleeding (defined as need for endoscopic, radiological or surgical haemostasis), in-hospital death (all cause) and readmission with further LGIB within 28 days 22. A patient scoring >8 points is classified as a major bleed, and is likely to benefit from hospital admission.…”

“…Although the Oakland score is both internally and externally validated, it has not been tested in populations beyond the UK. Additionally, owing to the liberal use of RBC transfusion in the population used to derive the score,6 it is likely to under-report the number of patients who can be safely discharged 22…”

“…It can also predict rebleeding and the need for RBC transfusion but is inferior at predicting mortality 22. The Glasgow-Blatchford score, which was designed for risk stratification in UGIB,23 has also been studied in patients with LGIB, and can identify patients at risk of adverse outcomes (rebleeding, need for RBC transfusion, in-hospital death) 22. It may be clinically useful when assessing the risk of adverse outcomes in patients who it is not safe to discharge.…”

“…This additional cost should be offset by the increased identification of patients who do not need acute admission. In the national audit, the average length of stay of patients with an Oakland score ≤8 was 4 days 22. An additional cost saving can be made by avoiding unnecessary transfusion, which accounts for as many as 80% of RBC transfusions 4…”