Oakland Score for Safe Discharge After Lower Gastrointestinal Bleeding

Aka: Oakland Score for Safe Discharge After Lower Gastrointestinal Bleeding

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II. Indications

  1. Disposition in Lower Gastrointestinal Bleeding

III. Criteria

  1. Age
    1. Score 0: Age<40 years
    2. Score 1: Age 40 to 69 years
    3. Score 2: Age >=70 years
  2. Gender
    1. Score 0: Female
    2. Score 1: Male
  3. Prior Lower Gastrointestinal Bleeding
    1. Score 0: No
    2. Score 1: Yes
  4. Digital Rectal Exam
    1. Score 0: No Blood
    2. Score 1: Blood
  5. Heart Rate
    1. Score 0: Heart Rate <70 beats/min
    2. Score 1: Heart Rate 70 to 89 beats/min
    3. Score 2: Heart Rate 90 to 109 beats/min
    4. Score 3: Heart Rate >110 beats/min
  6. Systolic Blood Pressure
    1. Score 0: Systolic Blood Pressure >=160 mmHg
    2. Score 2: Systolic Blood Pressure 130 to 159 mmHg
    3. Score 3: Systolic Blood Pressure 120 to 129 mmHg
    4. Score 4: Systolic Blood Pressure 90 to 119 mmHg
    5. Score 5: Systolic Blood Pressure 50 to 89 mmHg
  7. Hemoglobin
    1. Score 0: Hemoglobin >= 16.0 g/dl
    2. Score 4: Hemoglobin 13.0 to 15.9 g/dl
    3. Score 8: Hemoglobin 11.0 to 12.9 g/dl
    4. Score 13: Hemoglobin 9.0 to 10.9 g/dl
    5. Score 17: Hemoglobin 7.0 to 8.9 g/dl
    6. Score 22: Hemoglobin 3.6 to 6.9 g/dl

IV. Interpretation

  1. Total Score <=8 is consistent with safe discharge and outpatient follow-up
  2. At Score of <=8, risk of serious short-term complication <=1 to 5%
    1. Rebleeding
    2. Blood Transfusion required
    3. Therapeutic intervention required
    4. Readmission within 28 days
    5. Death

V. Efficacy

  1. General
    1. Low power for predicting GI Bleed disposition and home safety
    2. If used, should be used in combination with clinical judgment and other tools
  2. Major Bleeding when Oakland Score >8
    1. Test Sensitivity: 97%
    2. Test Specificity: 9%
    3. Positive Likelihood Ratio: 1.07
  3. Blood Transfusion when Oakland Score >8
    1. Test Sensitivity 99%
    2. Test Specificity: 12%
    3. Positive Likelihood Ratio: 1.14
  4. Safe Discharge <=8
    1. Test Sensitivity: 10%
    2. Test Specificity: 97%
    3. Negative Likelihood Ratio: 0.9
  5. References
    1. Almaghrabi (2022) JAMA Netw Open 5(5): e2214253 [PubMed]
    2. Evans (2025) Am Fam Physician 112(2): 200-2 [PubMed]

VI. Resources

  1. Oakland Score (MDCalc)
    1. https://www.mdcalc.com/calc/10042/oakland-score-safe-discharge-lower-gi-bleed

VII. References

  1. Oakland (2017) Lancet Gastroenterol Hepatol 2(9):635-43 +PMID: 28651935 [PubMed]

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