A Retrospective Audit of Per Rectal Bleeding Admissions at Dunedin Hospital from 2013 to 2020

Authors List

Amer, M., Department of Surgical Sciences, University of Otago, Dunedin, New Zealand Haddow, J., Department of Surgical Sciences, University of Otago, Dunedin, New Zealand

Introduction: Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospital admission. However, the majority resolve spontaneously and only a minority require inpatient intervention.

Aims: We aimed to determine the incidence of inpatient intervention in our institution. We also aimed to validate the Oakland Score, which can identify patients at low risk of adverse outcome from LGIB, in our population and determine the proportion who could have safely avoided admission.

Methods
: Using the prospective, validated Otago Clinical Audit database (DIVA), we searched for adult patients aged ≥18 years admitted with a primary diagnosis of LGIB between January 2013 and December 2020. We retrieved data to calculate the Oakland Score and details of inpatient treatment from the electronic patient record. We excluded patients admitted electively, acute admissions related to inflammatory bowel disease, and those with upper gastrointestinal bleeding.

Results
: We identified 761 patients of which 494 met inclusion criteria (56% male, median age 76 years, 82% NZ European). Overall, 62% did not require any inpatient treatment, 26% received a blood transfusion, and 7% required radiological, endoscopic, or surgical intervention to control bleeding. The area under the receiver operating characteristic curve for the Oakland Score was 0.83. A cut-off score of ≤10 was 95% sensitive for predicting safe avoidance of admission. This equates to avoiding 15 admissions and saving 30 bed-days per year.

Conclusion
: The majority of patients admitted to our hospital with LGIB do not require inpatient treatment. The Oakland Score could be used as a stratification tool to safely reduce the admission rate.

References
Oakland, K., Jairath, V., Uberoi, R., Guy, R., Ayaru, L., Mortensen, N., . . . Collins, G. S. (2017). Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol, 2(9), 635-643. doi: 10.1016/S2468-1253(17)30150-4

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