Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit

Oakland, Kathryn; Guy, Richard; Uberoi, Raman; Hogg, Rachel; Mortensen, Neil; Murphy, Michael; Jairath, Vipul

doi:10.1136/gutjnl-2016-313428

Cited by 122 publications

(304 citation statements)

References 26 publications

(43 reference statements)

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“…In the UK, in-hospital mortality is 3.4%, although this rises to 18% in patients who develop LGIB while already hospitalised,6 and 20% in patients with transfusion requirements of ≥4 units of red cells 5. Mortality is generally related to comorbidity, not exsanguinating haemorrhage 6.…”

Section: Introductionmentioning

confidence: 99%

“…Mortality is generally related to comorbidity, not exsanguinating haemorrhage 6. The majority of patients with LGIB are admitted to general surgical wards,5 and tend to be elderly with a high burden of comorbidity 6 7…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Flexible sigmoidoscopy and colonoscopy are the primary investigations,6 and can provide a means of endoscopic treatment, although this form of treatment is used in only 2.1% cases of LGIB in the UK 6. Radiological investigations such as general abdominal CT scanning or dedicated CT angiography (CTA) are used in over 25% of cases 6. If extravasation of contrast is shown on CTA, formal, invasive angiography with the option of mesenteric embolisation can be undertaken, although in practice embolisation is used in <1% of cases 6.…”

Section: Introductionmentioning

confidence: 99%

“…Radiological investigations such as general abdominal CT scanning or dedicated CT angiography (CTA) are used in over 25% of cases 6. If extravasation of contrast is shown on CTA, formal, invasive angiography with the option of mesenteric embolisation can be undertaken, although in practice embolisation is used in <1% of cases 6. Emergency laparotomy for bleeding is very uncommon 5 6…”

Section: Introductionmentioning

confidence: 99%

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

Oakland

Chadwick

East

et al. 2019

Gut

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Oakland

Chadwick

East

et al. 2019

Gut

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221

232

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External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US

et al. 2020

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IMPORTANCE Lower gastrointestinal bleeding (LGIB), which manifests as blood in the colon or anorectum, is a common reason for hospitalization. In most patients, LGIB stops spontaneously with no in-hospital intervention. A risk score that could identify patients at low risk of experiencing adverse outcomes could help improve the triage process and allow greater numbers of patients to receive outpatient management of LGIB. OBJECTIVE To externally validate the Oakland Score, which was previously developed using a score threshold of 8 points to identify patients with LGIB who are at low risk of adverse outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter prognostic study was conducted in 140 US hospitals in the Hospital Corporation of America network. A total of 46 179 adult patients (aged Ն16 years) admitted to the hospital with a primary diagnosis of LGIB between June 1, 2016, and October 15, 2018, were initially identified using diagnostic codes. Of those, 51 patients were excluded because they were more likely to have upper gastrointestinal bleeding, leaving a study population of 46 128 patients with LGIB. For the statistical analysis of the Oakland Score, an additional 8061 patients were excluded because they were missing data on Oakland Score components or clinical outcomes, resulting in 38 067 patients included in the analysis. The study used area under the receiver operating characteristic curves with 95% CIs for external validation of the model. Sensitivity and specificity were calculated for each score threshold (Յ8 points, Յ9 points, and Յ10 points).

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Comparison of Risk Scores for Lower Gastrointestinal Bleeding

Almaghrabi

Gandhi

Guizzetti³

et al. 2022

JAMA Netw Open

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Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit

Cited by 122 publications

References 26 publications

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

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

External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US

Comparison of Risk Scores for Lower Gastrointestinal Bleeding

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