Management of acute lower GI bleeding: evidence-based medicine?

Leeds, John S.; Jayaprakash, A.; Sanders, David S.

doi:10.1136/gutjnl-2019-319428

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…There were no patients in the highest strata of our scoring system, however, they would not be considered for discharge and management unaltered. Conversely, in the Oakland score derivation, no patients had some of the lowest scores suggesting this is difficult to obtain and the sensitivity of a low score may not be high 11,13 . One further limitation is separate scoring systems for the different adverse outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, in the Oakland score derivation, no patients had some of the lowest scores suggesting this is difficult to obtain and the sensitivity of a low score may not be high. 11 , 13 One further limitation is separate scoring systems for the different adverse outcomes. However, we show that rebleeding and mortality have different risk factors in LGIB and this is reflected in the modelling.…”

Section: Discussionmentioning

confidence: 99%

“…The Oakland score has been incorporated into national guidelines 12 recommending patients with a score >8 undergo urgent inpatient colonoscopy which lacks supporting evidence. [13][14][15][16] We analyzed our bleeding unit database to derive and validate a risk prediction model for patients admitted with acute LGIB and compare it with the Oakland score.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Derivation, validation, and comparison of a new prognostic scoring system for acute lower gastrointestinal bleeding

Smith,

Leggett,

Jayaprakash

et al. 2023

DEN Open

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ObjectivesLower gastrointestinal bleeding is a common presentation with little data concerning risk factors for adverse outcomes. The aim was to derive and validate a scoring system to stratify risk in lower gastrointestinal bleeding and compare it to the Oakland score.MethodsA total of 2385 consecutive patients (mean age 65 years, 1140 males) were used to derive the score using multivariate logistic regression modeling then internally and externally validated. The Oakland score was applied and area under receiver operating characteristic (AUROC) curves were calculated and compared. A score of <1 was compared with an Oakland score of <9 to assess 30‐day rebleeding and mortality rates.ResultsRebleeding was associated with age, inpatient bleeding, syncope, malignancy, tachycardia, hypotension, lower hemoglobin and mortality with age, inpatient bleeding, liver/gastrointestinal disease, tachycardia, and hypotension. The area under the receiver operating characteristic curves was 0.742 for rebleeding and 0.802 for mortality. A score <1 was associated with rebleeding (0.0%–2.2%) and mortality (0%). The Oakland score had a significantly lower area under the receiver operating characteristic curve for rebleeding of 0.687 but not for mortality; 0.757. A score <1 was associated with a lower 30‐day rebleeding risk compared to an Oakland score <9 (4/379 vs. 15/355, p = 0.009) but not mortality (0/365 vs. 1/355, p = 0.493).ConclusionsOur score predicts 30‐day rebleeding and mortality rate with low scores associated with very low risk. The Aberdeen score is superior to the Oakland score for predicting rebleeding. Prospective evaluation of both scores is required.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%