AIMS65 Score for Upper GI Bleeding Mortality
Why Use
Simple and quick to calculate. Uses information available prior to endoscopy. Highly predictive of mortality, cost, and LOS. Validated in a very large cohort.
When to Use
Patients with acute upper GI bleeding.
Formula
Pearls / Pitfalls
The AIMS65 Score for Upper GI Bleeding Mortality was designed to predict mortality in adults presenting with acute upper GI bleeding. Does not rely on endoscopic data and can be easily calculated in the ED. Each letter of the mnemonic (including “65”) represents an equally weighted risk factor that is cumulative in predicting severity of upper GI bleeding. Mortality increases with each positive risk factor. Cost and length of stay (LOS) also correlate closely with higher scores. Altered mental status is defined as Glasgow Coma Scale (GCS) score <14 or a physician designation of “disoriented,” “lethargy,” “stupor,” or “coma.” Of the 5 components, albumin was the single most predictive factor of mortality, perhaps as a surrogate of comorbid disease. The Glasgow-Blatchford Score (GBS) has demonstrated greater sensitivity and negative predictive value for low risk bleeding; therefore, a low AIMS65 score should not be used to dictate discharge ( Yaka 2013 ). A large multinational prospective trial demonstrated the GBS to be superior to the AIMS65 in predicting need for intervention (transfusion, endoscopic treatment, IR, or surgery) or rebleeding, although the AIMS65 remained a better predictor of mortality ( Stanley 2017 ). Due to its retrospective development from a large database, correlation with endoscopic outcomes, rebleeding rates, and transfusion requirements is not known. Point to Keep in Mind Only a small fraction (1.7%) of patients in the model were cirrhotic, although the AIMS65 score remains predictive of mortality in patients with liver disease ( Gaduputi 2014 ).
Management
Initial management should always focus on hemodynamic resuscitation prior to risk stratification.
More Information
AIMS65 Score In-hospital Mortality Rate 0 0.3% 1 1.2% 2 5.3% 3 10.3% 4 16.5% 5 24.5%