Risk Factor Score Could Reduce Gastrointestinal Bleeding Hospitalizations

Kathryn Oakland, MD

A new scoring system evaluating the severity and risk of adverse outcomes of patients with lower gastrointestinal bleeding (LGIB) could reduce the overall strain on the healthcare system.

A team, led by Kathryn Oakland, MD, Department of Digestive Diseases, HCA Healthcare UK, externally validated a risk factor scoring system dubbed the Oakland Score, which uses a 8-point score threshold to identify patients with lower gastrointestinal bleeding who at a low risk of adverse outcomes.

Lower gastrointestinal bleeding manifests itself as blood in the colon or anorectum, often leading to hospitalizations. For the majority of patients, this condition can subside, even without hospital intervention.

However, the UK-based research team believes by identifying a risk score for patients at a lower risk of adverse outcomes they could improve the triage process, allowing more individuals to receive outpatient treatment.

The multicenter prognostic study took place in 140 hospitals in the US that were part of the Hospital Corporation of America network, involving 46,179 patients at least 16 years old. Eligible patients had a primary diagnosis of LGIB between June 2016 and October 2018.

The mean age of the study population was 70.1 years old and 38,067 individuals were included in the final analysis.

The investigators used area under the receiver operating characteristics curves with 95% confidence intervals for external validation of the Oakland Score. They also calculated sensitivity and specificity for each score threshold (≤8 points, ≤9 points, and ≤10 points).

The investigators sought main outcomes of the identification of patients who met the criteria for safe discharge from the hospital and the comparison of the performance of a pair of score thresholds (≤8 points vs ≤10 points). They defined safe discharge as the absence of blood transfusion, rebleeding, hemostatic intervention, hospital readmission, and death.

A total of 22,074 patients (47.9%) met the criteria for a safe hospital discharge, with a mean age of 67.9 years old.

In the statistical analysis of the researcher’s model, the area under the receiver operating characteristic curve for safe discharge was 0.87 (95% CI, 0.87-0.87).

The investigators identified 3305 patients (8.7%) with an Oakland Score threshold of 8 points or lower, with a sensitivity and specificity for safe discharge of 98.4% and 16.0%, respectively.

Extension of the Oakland Score threshold to 10 points or lower identified 6770 patients (17.8%), with a sensitivity and specificity for safe discharge of 96.0% and 31.9%, respectively.

“In this study, the Oakland Score consistently identified patients with acute LGIB who were at low risk of experiencing adverse outcomes and whose conditions could safely be managed without hospitalization,” the authors wrote. “The score threshold to identify low-risk patients could be extended from 8 points or lower to 10 points or lower to allow identification of a greater proportion of low-risk patients.”

The study, “External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US,” was published online in JAMA Network Open.