Related Experiment Videos
Assessment of the Prognostic Performance of the Oakland Score in Lower Gastrointestinal Bleeding: A Retrospective
Sebnem Sahan1, Mehmet Emin Arayici2, Goksel Bengi3
1Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, 35340 İzmir, Türkiye.
Insights
The Oakland Score effectively predicts adverse outcomes in lower gastrointestinal bleeding (LGIB), including mortality and ICU admission. This risk stratification tool aids clinicians in managing LGIB patients, especially the elderly.
Area of Science:
- Gastroenterology
- Clinical Risk Stratification
- Emergency Medicine
Background:
- Lower gastrointestinal bleeding (LGIB) is a critical emergency, particularly impacting elderly and comorbid patients.
- Existing risk stratification tools for LGIB are underutilized, highlighting a need for improved clinical decision support.
- The Oakland Score was developed to identify patients with LGIB suitable for safe discharge.
Purpose of the Study:
- To identify prognostic factors in patients presenting with LGIB.
- To evaluate the association between the Oakland Score and adverse clinical outcomes.
- To assess the discriminative performance of the Oakland Score in predicting LGIB complications.
Main Methods:
- Retrospective, single-center study of 890 adult patients with LGIB from 2015-2024.
- Calculation of the Oakland Score for all included patients.
- Analysis of the score's association with mortality, ICU admission, transfusions, rebleeding, and emergency surgery using ROC analysis and multivariable logistic regression.
Main Results:
- The Oakland Score demonstrated significant associations with mortality, ICU admission, blood product transfusion, and rebleeding (p < 0.05).
- The score showed strong discriminative performance for ICU admission (AUC 0.754) and mortality (AUC 0.706).
- The Oakland Score independently predicted one-month rebleeding (OR 1.082), but not mortality or ICU admission after multivariable adjustment.
Conclusions:
- The Oakland Score is significantly associated with major adverse outcomes in LGIB patients.
- The score is particularly sensitive for predicting mortality and ICU admission.
- The Oakland Score serves as a valuable adjunct for clinical judgment in LGIB risk stratification.
Abstract:
Background/Objectives: Lower gastrointestinal bleeding (LGIB) is a common and potentially life-threatening emergency that disproportionately affects elderly, comorbid patients, yet evidence-based risk stratification tools remain underused. The Oakland Score was developed to identify patients who can be safely discharged. This study aimed to determine prognostic factors in patients presenting with LGIB and to evaluate the relationship between the Oakland Score and adverse clinical outcomes. Methods: In this single-centre, retrospective, descriptive study, patients aged 18 years and older who presented to the emergency department with LGIB between 2015 and 2024, and who were evaluated, treated and followed up by the Department of Gastroenterology at Dokuz Eylül University, and who underwent endoscopic evaluation were reviewed. A total of 890 patients who met the inclusion criteria and had complete medical records, defined as full availability of all Oakland Score variables and primary outcome data, were included in the final analysis. The Oakland Score was calculated for every patient, and its association with mortality, intensive care unit (ICU) admission, blood-product transfusion, early and late rebleeding, and the need for emergency surgery was analysed. Receiver operating characteristic (ROC) analysis was used to assess discriminative performance. Results: The mean age was 69.8 ± 15.6 years, and 50.4% of patients were female. The most frequent comorbidities were hypertension (56.2%), coronary artery disease (28.9%) and diabetes mellitus (25.1%). Diverticular bleeding was the most common aetiology (25.1%). Red blood cell transfusion was required in 52.8% of patients, and the in-hospital mortality rate was 6.1%. The Oakland Score was significantly associated with mortality, ICU admission, blood-product transfusion, early and late rebleeding, and emergency surgery (all p < 0.05). On ROC analysis the score performed best for ICU admission (AUC 0.754) and mortality (AUC 0.706), and was significantly associated with red blood cell, platelet and fresh frozen plasma transfusion requirements (p < 0.001). On multivariable logistic regression, the Oakland Score was an independent predictor of one-month rebleeding (OR 1.082; 95% CI 1.032-1.133; p = 0.001) but did not retain independent significance for mortality or ICU admission after adjustment for malignancy, serum albumin and BUN. Conclusions: The Oakland Score is significantly associated with major adverse outcomes in LGIB and is particularly sensitive for predicting mortality and ICU admission. It is a useful adjunct to clinical judgement for risk stratification, although it should be interpreted alongside the patient's overall clinical status.