Oakland score for lower gastrointestinal bleeding

What goes into the Oakland score

• Age: < 40 (0); 40–69 (1); ≥ 70 (2)
• Sex: Female (0); Male (1)
• Previous admission for lower GI bleeding (+1)
• Blood on rectal exam (+1)
• Heart rate: < 70 (0); 70–89 (1); 90–109 (2); ≥ 110 (3)
• Systolic BP: ≥ 160 (0); 130–159 (2); 120–129 (3); 90–119 (4); 50–89 (5)
• Hemoglobin: ≥ 16 g/dL (0); 13–15.9 g/dL (4); 11–12.9 g/dL (8); 9–10.9 g/dL (13); 7–8.9 g/dL (17); < 7 g/dL (22)

How to interpret the result

• ≤ 8: about 95% probability of safe discharge
• > 8: admit

Clinical pearls

• Hemodynamically unstable hematochezia may be an upper GI bleed: check BUN and consider upper endoscopy.
• Colonoscopy is not usually urgent; CT angiography first if bleeding is brisk.
• Use the Glasgow-Blatchford score for suspected upper GI bleeding instead.

Evidence

1. Oakland K, 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;2:635-643.

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