Jeong Ha, MBCHB (Otago) 2014 is currently a General Surgical Registrar at HVDHB and CCDHB.
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Risk Assessment of Lower Gastrointestinal Bleeding
Aims: Acute lower gastrointestinal (LGI) bleeding frequently leads to a hospital admissions. Unlike upper gastrointestinal bleed, LGI bleed lacks a well-established model that stratifies risks to aid decision making. The Oakland score, a risk assessing tool was developed in 2017 [1] with outpatient management of LGI bleed considered safe for scores ≤8. Our aim was to review the existing practice in Wellington Hospital, to assess whether the Oakland score can be used to deliver safe surgical care, avoiding unnecessary admissions.
Methods: Retrospective review of patients presenting with painless LGI bleed from January 2017 to December 2018. The Oakland score at presentation was measured. Admission, length of hospital stay, investigations and / or treatment (surgery, transfusion, embolization) and outcomes were recorded.
Results: 120 patients were assessed with 91 managed as inpatients. Fifteen of the 91 had Oakland score ≤8, not one required intervention or treatment. The average length of hospital stay for these low risk patients were 1.5 days which could have been avoided. Forty-nine of those with Oakland score >9 also had no intervention or treatment. The remaining 27 were investigated (17) and / or had active treatment including surgery (26), all had a score ≥11.
Conclusions: The use of the Oakland score would have reduced admission by approximately 16%, saving a conservative NZ$27,0002. In our population it may also be safe to discharge those with a score of 9 or 10 making additional savings. Prospective use of the Oakland score should determine the appropriate score at which patients must be admitted and help deliver cost-effective and safe management of LGI bleeds.
References
Oakland K, Guy R, Uberoi R. 2018. Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit. Gut;67:654-662.
