Oakland score to identify low-risk patients with lower gastrointestinal bleeding performs well among emergency department patients
Dublin Core
Title
Oakland score to identify low-risk patients with lower gastrointestinal bleeding performs well among emergency department patients
Subject
Lower gastrointestinal bleeding, Risk stratification, Emergency medicine
Description
Abstract
Background The Oakland Score predicts risk of 30-day adverse events among hospitalized patients with lower
gastrointestinal bleeding (LGIB) possibly identifying patients who may be safe for discharge. The Oakland Score has
not been studied among emergency department (ED) patients with LGIB. The Oakland Score composite outcome
includes re-bleeding, defined as additional blood transfusion requirements and/or a further decrease in hematocrit
(Hct) >/= 20% after 24 h in clinical stability; red blood cell transfusion; therapeutic intervention to control bleeding,
including surgery, mesenteric embolization, or endoscopic hemostasis; in-hospital death, all cause; and re-admission
with further LGIB within 28 days. Prediction variables include age, sex, previous LGIB admission, systolic blood
pressure, heart rate, and hemoglobin concentration, and scores range from 0 to 35 points, with higher scores
indicating greater risk.
Methods Retrospective cohort study of adult (≥18 years old) patients with a primary ED diagnosis of LGIB across
21 EDs from March 1st, 2018, through March 1st, 2020. We excluded patients who were more likely to have upper
gastrointestinal bleeding (esophago-gastroduodenoscopy without LGIB evaluation), patients who left against
medical advice or prior to ED provider evaluation, ED patients without active health plan membership, and patients
with incomplete Oakland Score variables. We assessed predictive accuracy by reporting the area under the receiver
operator curve (AUROC) and sensitivity, specificity, positive and negative predictive values, and positive and negative
likelihood ratios at multiple clinically relevant thresholds.
Results We identified 8,283 patients with LGIB, 52% were female, mean age was 68, 49% were non-White, and 27%
had an adverse event. The AUROC for predicting an adverse event was 0.85 (95% CI 0.84–0.86). There were 1,358
patients with an Oakland Score of </=8; 4.9% had an adverse event, and sensitivity of the Oakland Score at this
threshold was 97% (95% CI 96%−98%).
Background The Oakland Score predicts risk of 30-day adverse events among hospitalized patients with lower
gastrointestinal bleeding (LGIB) possibly identifying patients who may be safe for discharge. The Oakland Score has
not been studied among emergency department (ED) patients with LGIB. The Oakland Score composite outcome
includes re-bleeding, defined as additional blood transfusion requirements and/or a further decrease in hematocrit
(Hct) >/= 20% after 24 h in clinical stability; red blood cell transfusion; therapeutic intervention to control bleeding,
including surgery, mesenteric embolization, or endoscopic hemostasis; in-hospital death, all cause; and re-admission
with further LGIB within 28 days. Prediction variables include age, sex, previous LGIB admission, systolic blood
pressure, heart rate, and hemoglobin concentration, and scores range from 0 to 35 points, with higher scores
indicating greater risk.
Methods Retrospective cohort study of adult (≥18 years old) patients with a primary ED diagnosis of LGIB across
21 EDs from March 1st, 2018, through March 1st, 2020. We excluded patients who were more likely to have upper
gastrointestinal bleeding (esophago-gastroduodenoscopy without LGIB evaluation), patients who left against
medical advice or prior to ED provider evaluation, ED patients without active health plan membership, and patients
with incomplete Oakland Score variables. We assessed predictive accuracy by reporting the area under the receiver
operator curve (AUROC) and sensitivity, specificity, positive and negative predictive values, and positive and negative
likelihood ratios at multiple clinically relevant thresholds.
Results We identified 8,283 patients with LGIB, 52% were female, mean age was 68, 49% were non-White, and 27%
had an adverse event. The AUROC for predicting an adverse event was 0.85 (95% CI 0.84–0.86). There were 1,358
patients with an Oakland Score of </=8; 4.9% had an adverse event, and sensitivity of the Oakland Score at this
threshold was 97% (95% CI 96%−98%).
Creator
Daniel D. DiLena1*, Sean C. Bouvet2
, Madeline J. Somers1
, Maqdooda A. Merchant1
, Theodore R. Levin1,3, Adina
S. Rauchwerger1
and Dana R. Sax1,4
, Madeline J. Somers1
, Maqdooda A. Merchant1
, Theodore R. Levin1,3, Adina
S. Rauchwerger1
and Dana R. Sax1,4
Source
https://doi.org/10.1186/s12245-025-00815-5
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Daniel D. DiLena1*, Sean C. Bouvet2
, Madeline J. Somers1
, Maqdooda A. Merchant1
, Theodore R. Levin1,3, Adina
S. Rauchwerger1
and Dana R. Sax1,4, “Oakland score to identify low-risk patients with lower gastrointestinal bleeding performs well among emergency department patients,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12634.