Comparison of Risk Scores for Lower Gastrointestinal Bleeding

Almaghrabi, Majed; Gandhi, M; Guizzetti, Leonardo; Iansavichene, Alla; Yan, Brian; Wilson, Aze; Oakland, Kathryn; Jairath, Vipul; Sey, Michael

doi:10.1001/jamanetworkopen.2022.14253

Cited by 17 publications

(11 citation statements)

References 43 publications

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“…Over the years, numerous LGIB risk stratification scores have been developed. 10 Examples of such scores include the Oakland score, the BLEED (ongoing bleeding, low systolic blood pressure, elevated prothrombin time, erratic mental status and unstable comorbid disease) score, the NOBLADS (nonsteroidal anti-inflammatory drug use, no diarrhoea, no abdominal tenderness, blood pressure ⩽ 100 mmHg, antiplatelet drug use (nonaspirin), albumin < 3.0 g/ dL, disease score ⩾2 (according to the Charlson Comorbidity Index) and syncope) score, the Strate score and the Sengupta score. Some of the scores have been developed to identify low-risk patients, while others have been developed to predict severe bleeding, in-hospital complication or death.…”

Section: Discussionmentioning

confidence: 99%

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

Fong

2023

Hong Kong Journal of Emergency Medicine

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Objective: To externally validate the use of the Oakland score in identification of low-risk lower gastrointestinal bleeding patients who can be safely managed without hospitalisation in an accident and emergency department in Hong Kong. Methods: This single-centre retrospective cohort study included adult patients who attended the accident and emergency department for lower gastrointestinal bleeding and were subsequently admitted to hospital from 1 January 2020 to 31 December 2020. Safe discharge was defined as absence of all of the following adverse outcomes after hospital presentation: blood transfusion; therapeutic colonoscopy, mesenteric embolisation, or laparotomy for bleeding; in-hospital death (all causes); and readmission with subsequent lower gastrointestinal bleeding within 28 days. The sensitivities, specificities and area under the receiver-operating characteristic curve of the Oakland score were calculated. Results: Among 376 patients who were included in this study, 114 (30.3%) of them experienced one or more adverse outcomes. The area under the receiver-operating characteristic curve for safe discharge was 0.88 (95% confidence interval, 0.84–0.91). Using an Oakland score threshold of ⩽8 points as in the original derivation study can achieve 100% sensitivity (95% confidence interval, 96.8%–100%) and 7.3% specificity (95% confidence interval, 4.4%–11.1%) for safe discharge. When the Oakland score threshold was extended to ⩽11 points, a much greater proportion of low-risk patients could be identified, with 97.4% sensitivity (95% confidence interval, 92.5%–99.5%) and 32.8% specificity (95% confidence interval, 27.2%–38.9%) for safe discharge. Conclusion: The Oakland score performed well in identification of lower gastrointestinal bleeding patients who were at low risk of experiencing adverse outcomes and could thus be safely managed without hospitalisation. Extension of the Oakland score threshold to ⩽11 points can allow identification of a greater proportion of low-risk patients while sensitivity is reasonably maintained.

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Section: Discussionmentioning

confidence: 99%

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

Fong

2023

Hong Kong Journal of Emergency Medicine

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“…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 30 …”

Section: Discussionmentioning

confidence: 99%

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

Prasitvarakul,

Attanath,

Chang

2023

World j. surg.

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BackgroundThis study aimed to determine the performance of the Oakland, Glasgow‐Blatchford, and AIMS65 scores in predicting the clinical outcomes of acute lower gastrointestinal bleeding (LGIB).MethodsThis prospective cohort study was conducted from July 2020 to July 2021. Patients admitted with acute lower gastrointestinal bleeding were enrolled. The Oakland, Glasgow‐Blatchford, and AIMS65 scores were calculated. The primary outcome was validating the performance of the scores in predicting severe LGIB; secondary outcomes were comparing the performance of the scores in predicting the need for blood transfusion, hemostatic interventions, in‐hospital rebleeding, and mortality. Receiver operating characteristic curves were calculated for all outcomes. The associations between all three scores and the primary outcomes were calculated using multivariate logistic regression analysis.ResultsPatients with acute LGIB (n = 150) were enrolled (88 [58.7%] men and mean age: 63.6 ± 17.3 years). The rates of severe LGIB, need for blood transfusion, hemostatic intervention, in‐hospital rebleeding, and in‐hospital mortality were 54.7%, 79.3%, 10.7%, and 3.3%, respectively. The Oakland and Glasgow‐Blatchford scores had comparable performance in predicting severe LGIB, need for blood transfusion, and mortality, outperforming the AIMS65 score. All scores were suboptimal for predicting hemostatic interventions and rebleeding.ConclusionsOur results demonstrate the predictive performances of the Oakland score and the GBS are excellent and comparable for severe LGIB, the need for blood transfusion, and in‐hospital mortality in patients with acute LGIB. Thus, GBS could be considered as an alternative predictive score for stratification of the patients with acute LGIB.

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“…Compared with other existing tools for LGIB risk-stratification, the Oakland score has been shown to be the best predictor for severe bleeding [22], and in a recent meta-analysis comparing four validated LGIB risk-stratification scores, the Oakland score was reported to be the best predictor for safe patient discharge, major bleeding, and need for blood transfusion [23 ▪▪ ].…”

Section: Patient Presentationmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding

Elimeleh,

Gralnek

2023

Current Opinion in Gastroenterology

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Purpose of review We review and summarize the most recent literature, including evidence-based guidelines, on the evaluation and management of acute lower gastrointestinal bleeding (LGIB). Recent findings LGIB primarily presents in the elderly, often on the background of comorbidities, and constitutes a significant healthcare and economic burden worldwide. Therefore, acute LGIB requires rapid evaluation, informed decision-making, and evidence-based management decisions. LGIB management involves withholding and possibly reversing precipitating medications and concurrently addressing risk factors, with definitive diagnosis and therapy for the source of bleeding usually performed by endoscopic or radiological means. Recent advancements in LGIB diagnosis and management, including risk stratification tools and novel endoscopic therapeutic techniques have improved LGIB management and patient outcomes. In recent years, the various society guidelines on acute lower gastrointestinal bleeding have been revised and updated accordingly. Summary By integrating the most recently published high-quality clinical studies and society guidelines, we provide clinicians with an up-to-date and comprehensive overview on acute LGIB diagnosis and management.

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Comparison of Risk Scores for Lower Gastrointestinal Bleeding

Abstract: IMPORTANCE Clinical prediction models, or risk scores, can be used to risk stratify patients with lower gastrointestinal bleeding (LGIB), although the most discriminative score is unknown. OBJECTIVE To identify allLGIB risk scores available and compare their prognostic performance.

Cited by 17 publications

References 43 publications

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

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

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

Diagnosis and management of acute lower gastrointestinal bleeding

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