Predictive value of clinical risk scores for adverse outcomes and safe discharge in acute lower gastrointestinal bleeding.

BACKGROUND

This study aims to evaluate the predictive value of various clinical prediction tools in predicting adverse outcomes and safe discharge in patients with lower gastrointestinal bleeding (LGIB).

METHODS

This retrospective cohort study was conducted in the emergency department of a tertiary training and research hospital between October 1, 2017, and October 1, 2022. Adult patients (≥18 years) with a final diagnosis of acute LGIB were included. Demographics, medication history, chief complaints, vital signs, physical examination findings, laboratory results, bleeding sources, adverse outcomes (in-hospital mortality, severe bleeding, transfusion needs, and therapeutic interventions), and the variables needed to calculate the CHAMPS, NOBLADS, Oakland, SALGIB, and Strate scores were recorded, and analysis was performed.

RESULTS

A total of 2051 patients were included in the final analysis. The median age of the patients was 59 years (IQR: 42-75), and 40.7 % were female. An adverse outcome occurred in 792 (38.6 %) patients, and severe bleeding occurred in 611 patients (29.8 %). A total of 752 patients (36.7 %) required blood transfusions, and 67 patients (3.3 %) underwent therapeutic intervention. The Oakland score demonstrated the highest predictive performance for adverse outcomes (AUC: 0.902), severe bleeding (AUC: 0.925), and safe discharge (AUC: 0.889). The SALGIB score followed, with AUC values of 0.880, 0.901, and 0.867, respectively, for the same outcomes. The remaining scores exhibited moderate predictive performance across all three outcomes.

CONCLUSION

The Oakland and SALGIB scores outperformed other clinical prediction tools and may aid clinicians in identifying patients at risk of adverse outcomes and making safe discharge decisions in acute LGIB.