目的:开发奥克兰评分以预测下消化道出血(LGIB)急诊患者的安全出院。在这项研究中,我们回顾性评估了该评分是否可用于评估WellStar亚特兰大医学中心(WAMC)的安全出院(评分≤10).
方法:对2020年1月1日至2021年12月30日WAMC收治的108例患者进行了回顾性队列研究。包括基于ICD-10代码的LGIB患者。奥克兰评分是使用7个变量(年龄,性别,上一个LGIB,直肠指检,脉搏,所有患者入院和出院时的收缩压(SBP)和血红蛋白(Hgb)。总得分范围从0到35,得分≤10是已显示可预测安全出院的截止值。Hgb和SBP是得分的主要贡献者,较低的值对应于较高的奥克兰分数。使用SPSS23软件进行描述性和多变量分析。
结果:共有108例患者符合纳入标准,53(49.1%)是女性,种族分布如下:89(82.4%)非洲裔美国人,17名(15.7%)高加索人,和另外2个(1.9%)。69.4%的患者进行了结肠镜检查;61.1%的患者在住院期间需要输血。入院和出院时的平均SBP记录分别为129.0(95%CI,124.0-134.1)和130.7(95%CI,125.7-135.8),分别。大多数(59.2%)患者有基线贫血,住院前基线时平均Hgb值为11.0(95%CI,10.5-11.5)g/dL,到达时8.8(95%CI,8.2-9.5)g/dL,出院时9.4(95%CI,9.0-9.7)g/dL。一入场,100/108(92.6%)患者的奥克兰评分>10,其中几乎所有患者(104/108(96.2%))在出院时持续升高奥克兰评分大于10。即使,奥克兰的平均评分从抵达当天的21.7(95%CI,20.4-23.1)提高到出院时的20.3(95%CI,19.4-21.2),只有4/108(3.7%)的患者出院时奥克兰评分≤10.尽管如此,在1年随访期间,只有9/108(8.33%)需要LGIB再入院.我们发现,既往LGIB的入院史与再入院相关,调整后的比值比为4.42(95%CI,1.010-19.348,p=0.048)。
结论:在这项研究中,几乎所有入院时奥克兰评分>10的患者在出院时的评分仍高于10.如果将奥克兰评分作为出院的唯一标准,大多数患者将不符合出院标准。有趣的是,尽管出院时奥克兰评分升高,但这些患者中的大多数不需要再次入院,这表明奥克兰评分并不能真正预测安全出院。一个潜在的混淆是奥克兰评分在计算过程中没有考虑基线贫血。一项前瞻性研究评估考虑基线贫血的改良奥克兰评分可能会增加该患者人群的价值。
OBJECTIVE: The Oakland score was developed to predict safe discharge in patients who present to the emergency department with lower gastrointestinal bleeding (LGIB). In this study, we retrospectively evaluated if this score can be implemented to assess safe discharge (score ≤ 10) at WellStar Atlanta Medical Center (WAMC).
METHODS: A retrospective cohort study of 108 patients admitted at WAMC from January 1, 2020 to December 30, 2021 was performed. Patients with LGIB based on the ICD-10 codes were included. Oakland score was calculated using 7 variables (age, sex, previous LGIB, digital rectal exam, pulse, systolic blood pressure (SBP) and hemoglobin (Hgb)) for all patients at admission and discharge from the hospital. The total score ranges from 0 to 35 and a score of ≤ 10 is a cut-off that has been shown to predict safe discharge. Hgb and SBP are the main contributors to the score, where lower values correspond to a higher Oakland score. Descriptive and multivariate analysis was performed using SPSS 23 software.
RESULTS: A total of 108 patients met the inclusion criteria, 53 (49.1%) were female with racial distribution was as follows: 89 (82.4%) African Americans, 17 (15.7%) Caucasian, and 2 (1.9%) others. Colonoscopy was performed in 69.4% patients; and 61.1% patients required blood transfusion during hospitalization. Mean SBP records at admission and discharge were 129.0 (95% CI, 124.0-134.1) and 130.7 (95% CI,125.7-135.8), respectively. The majority (59.2%) of patients had baseline anemia and the mean Hgb values were 11.0 (95% CI, 10.5-11.5) g/dL at baseline prior to hospitalization, 8.8 (95% CI, 8.2-9.5) g/dL on arrival and 9.4 (95% CI, 9.0-9.7) g/dL at discharge from hospital. On admission, 100/108 (92.6%) of patients had an Oakland score of > 10 of which almost all patients (104/108 (96.2%)) continued to have persistent elevation of Oakland Score greater than 10 at discharge. Even though, the mean Oakland score improved from 21.7 (95% CI, 20.4-23.1) of the day of arrival to 20.3 (95% CI, 19.4-21.2) at discharge, only 4/108 (3.7%) of patients had an Oakland score of ≤ 10 at discharge. Despite this, only 9/108 (8.33%) required readmission for LGIB during a 1-year follow-up. We found that history of admission for previous LGIB was associated with readmission with adjusted odds ratio 4.42 (95% CI, 1.010-19.348, p = 0.048).
CONCLUSIONS: In this study, nearly all patients who had Oakland score of > 10 at admission continued to have a score above 10 at discharge. If the Oakland Score was used as the sole criteria for discharge most patients would not have met discharge criteria. Interestingly, most of these patients did not require readmission despite an elevated Oakland score at time of discharge, indicating the Oakland score did not really predict safe discharge. A potential confounder was the Oakland score did not consider baseline anemia during calculation. A prospective study to evaluate a modified Oakland score that considers baseline anemia could add value in this patient population.