Oakland Score for Safe Discharge After Lower GI Bleed

Oakland Score

Age

Sex

Prior Lower GI Bleed Admission

DRE Findings

Heart Rate

Systolic Blood Pressure

Hemoglobin

Score:–

–

Readmission and adverse event risk in patients with acute lower GI bleeding.

Why Use

Uses readily available demographic and clinical variables to predict both the safety of discharge and the risk of major adverse events, including major bleeding, the need for blood transfusion, or interventions to achieve hemostasis. Helps assess the risk of adverse outcomes and determine whether a patient is a suitable candidate for outpatient management.

When to Use

In emergency department patients who present with lower gastrointestinal bleeding (LGIB).

Formula

Addition of the selected points: Variable Points Age, years <40 0 40-69 1 ≥70 2 Sex Female 0 Male 1 Previous lower GI bleeding admission No 0 Yes 1 DRE findings No blood 0 Blood 1 Heart rate, bpm <70 0 70-89 1 90-109 2 ≥110 3 Systolic blood pressure, mmHg 50-89 5 90-119 4 120-129 3 130-159 2 ≥160 0 Hemoglobin, g/L (g/dL) 36-69 (3.6-6.9) 22 70-89 (7-8.9) 17 90-109 (9-10.9) 13 110-129 (11-12.9) 8 130-159 (13-15.9) 4 ≥160 (16) 0

Pearls / Pitfalls

A score of ≤ 8 does not have sufficient diagnostic accuracy to independently justify discharge for outpatient work up. A score >8 is specific for predicting adverse events including readmission, major hemorrhage, and blood transfusion requirement; and that the patient may not be safe for discharge.

Management

The original score was created and validated using a cutoff of ≤8. Scores >8 identify high-risk patients who may need hospital admission. Clinical judgment should always be utilized when determining disposition planning for patients with suspected lower GI bleed.

More Information

Interpretation: Score Probability of safe discharge* Recommendation** 0-2 99% Consider discharge, with appropriate precautions 3-4 98% 5 97% 6-7 96% 8 95% 9 93% Admission with further workup and resuscitation as necessary 10 91% 11 89% 12-13 87-89% 14-15 77-81% 16-17 67-72% 18-20 50-62% 21-23 33-45% 24-26 20-28% 27-29 11-16% ≥30 0-1% *Defined as absence of rebleeding, blood transfusion, therapeutic intervention, 28 day readmission, or death. **From Cañamares 2017 .