Oakland Score for Lower GI Bleeding
Facilitates deciding whether safe discharge of patients after Lower GI Bleeding (LGIB) is possible or not.
Refer to the text below the calculator for more information about the score and its application in clinical practice.
The Oakland Score helps risk-stratify patients presenting with lower gastrointestinal bleeding who are at low risk of adverse outcomes and likely to not need any in-hospital intervention.
- Safe discharge is defined as absence of rebleeding, blood transfusion, therapeutic intervention, 28-day readmission, or death.
- For scores 0 – 8: Consider discharge, with appropriate precautions.
- For scores >8: Admission with further workup and resuscitation as necessary.
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The Oakland Score for LGIB Explained
The Oakland Score is used in emergency and primary care settings to determine whether safe discharge and outpatient management is feasible in the case of patients presenting with lower gastrointestinal bleeding.
Safe discharge is defined as absence of rebleeding, blood transfusion, therapeutic intervention, 28-day readmission, or death.
The Oakland Score was developed from prospective data obtained from 2,336 patients with LGIB across 143 hospitals in the United Kingdom. Multivariable logistic regression modelling was used to identify predictors of safe discharge.
Further validation took place in 288 patients (out of which 184 were safely discharged) across 2 hospitals.
Age, sex, previous admission for lower gastrointestinal bleeding, rectal examination findings, heart rate, systolic blood pressure, and haemoglobin concentration strongly discriminated safe discharge in the development cohort (C statistic 0·84, 95% CI 0·82–0·86) and in the validation cohort (0·79, 0·73–0·84).
| Oakland Score items | Answer choices | Pts |
| Age | <40 years | 0 |
| 40 – 69 years | 1 | |
| ≥70 years | 2 | |
| Sex | Female | 0 |
| Male | 1 | |
| Previous lower GI bleeding admission | No | 0 |
| Yes | 1 | |
| Digital rectal exam findings | No blood | 0 |
| Blood | 1 | |
| Heart rate (bpm) | <70 | 0 |
| 70 - 89 | 1 | |
| 90 - 109 | 2 | |
| ≥110 | 3 | |
| Systolic blood pressure (mmHg) | 50 - 90 | 5 |
| 90 - 119 | 4 | |
| 120 - 129 | 3 | |
| 130 - 159 | 2 | |
| ≥160 | 0 | |
| Hemoglobin g/dL (g/L) | 3.6 - 6.9 (36 - 69) | 22 |
| 7.0 - 8.9 (70 - 89) | 17 | |
| 9.0 - 10.9 (90 - 109) | 13 | |
| 11.0 - 12.9 (110 - 129) | 8 | |
| 13.0 - 15.9 (130 – 159) | 4 | |
| ≥16.0 (160) | 0 |
Oakland Scores range from 0 to 35. As a rule of thumb, patients with minor, self-limiting bleed (characteristic of scores of 8 points or less) may be discharged for urgent outpatient investigation. Patients with major bleed (scores greater than 8 points) should be admitted for colonoscopy and in case they are or become hemodynamically unstable should be admitted for urgent CT angiography.
Oakland Score and Probability of Safe Discharge
| Score | Probability of safe discharge | Score | Probability of safe discharge |
| 0 - 2 | 99% | 12 - 13 | 87 - 89% |
| 3 - 4 | 98% | 14 - 15 | 77 - 81% |
| 5 | 97% | 16 - 17 | 67 - 72% |
| 6 -7 | 96% | 18 - 20 | 50 - 62% |
| 8 | 95% | 21 - 23 | 33 - 45% |
| 9 | 93% | 24 - 26 | 20 - 28% |
| 10 | 91% | 27 - 29 | 11 - 16% |
| 11 | 89% | ≥30 | 0 - 1% |
References
Original reference
Oakland K, Jairath V, Uberoi R, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol. 2017; 2(9):635-643.
Validation
Oakland K, Kothiwale S, Forehand T, et al. External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US. JAMA Netw Open. 2020; 3(7):e209630.
Other references
Cañamares P, Alfaro E, Lanas A. Safe hospital discharge based on lower GI bleeding scores: a long way to go. AME Medical Journal. 2017; 2:147-147.
Specialty: Gastroenterology
System: Digestive
Year Of Study: 2017
Article By: Denise Nedea
Published On: October 16, 2020 · 12:00 AM
Last Checked: October 16, 2020
Next Review: October 16, 2025