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Abstract：
Introduction Lower gastrointestinal bleeds (LGIB) are defined by having a bleeding point in the gastrointestinal tract beyond the ligament of Treitz. The most common causes include diverticular bleeds, tumours, and colitis. There are no National Institute for Health and Care Excellence (NICE) guidelines regarding safe discharge of patients with LGIB. The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology (BSG) guidelines, in patients presenting with LGIB at William Harvey Hospital. Methods Patients with LGIB who presented to Accident & Emergency or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patients\' Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients\' admission, discharges, and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. Patients with no adverse outcomes were deemed to have had a safe discharge. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome (and therefore safe discharge) were calculated. Results A total of 123 patients were included. These led to a total of 144 LGIB presentations to the hospital. Twenty-nine patients had an Oakland score of ≤8; 21 (72.4%) cases were initially discharged with four representations (19.0%) and eight (27.6%) were admitted although none of these suffered from any adverse outcomes. For those who scored ≤8, 25 (86.2%) were therefore deemed to have had a safe discharge. A total of 115 had a score >8; 43 (37.4%) were initially discharged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome including 16 (13.9%) representations, 21 (18.3%) blood transfusions, three (2.6%) surgical interventions and one (0.9%) endoscopic haemostasis. Out of the 115 cases which scored >8, 74 (64.3%) were deemed to have had a safe discharge. The AUROC for safe discharge was 0.84. Conclusion The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score of >8 could be used as many patients with a higher score did not experience adverse outcomes.
摘要：
引言下胃肠道出血(LGIB)通过在胃肠道中具有超出Treitz韧带的出血点来定义。最常见的原因包括憩室出血，肿瘤,和结肠炎。没有关于LGIB患者安全出院的国家健康与护理卓越研究所（NICE）指南。这项研究的目的是调查奥克兰评分的有效性和安全性，根据英国胃肠病学会（BSG）指南的建议，威廉·哈维医院的LGIB患者。方法本回顾性研究包括2023年1月至12月在急诊或住院转诊的LGIB患者。数据从患者\'日出文件中提取。计算每位患者的奥克兰评分。得分≤8的人被认为可以安全出院；得分较高的人被认为不合适。患者入院，放电,和不良结果，比如代表性，输血,或进一步干预，被调查了。无不良结局的患者被认为已安全出院。计算了奥克兰评分和不良后果（因此安全出院）的受试者工作特征曲线下面积（AUROC）。结果共纳入123例患者。这些导致总共144个LGIB报告给医院。29例患者的奥克兰评分≤8分；21例（72.4％）最初出院，其中4例（19.0％）和8例（27.6％）入院，尽管这些患者均未出现任何不良后果。对于得分≤8的人，因此认为25（86.2％）已安全出院。共有115人评分>8分;43人(37.4%)最初出院,72（62.6％）入院和41（35.7％）经历了至少一种不良结果，包括16（13.9％）代表，21次（18.3%）输血，3（2.6％）手术干预和1（0.9％）内窥镜止血。在评分>8的115例中，有74例（64.3％）被认为安全出院。安全出院的AUROC为0.84。结论奥克兰评分似乎是确定无需医院干预即可安全出院的LGIB患者的安全可靠的工具。然而,需要进一步的研究来评估是否可以使用评分>8,因为许多评分较高的患者没有出现不良结局.
