New guidelines on lower GI bleeding
Background: Lower GI bleeding (LGIB) is a fairly common ED presentation, but it may surprise you to learn that there are no UK national guidelines on the acute management of this condition. Who can go home? Who needs admission? What is the best initial management? Thankfully, the British Society of Gastroenterology has recently published a paper covering all of this, and it's a big one: stakeholders include the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists and NHS Blood and Transplant.
Summary of recommendations
"This article is really interesting: a useful summary for ourselves and the admitting speciality. The Oakland score looks promising, as it seems to have fairly standard criteria on it."
(Dr Robert Tan, ED Consultant)
More on the Oakland score:
The score can be found on MDCalc. It predicts the probability of safe discharge, specifically the absence of rebleeding, transfusion, interventions, readmission or death at 28 days. It is based on 7 variables: age, sex, history of LGIB, blood on PR, heart rate, blood pressure and haemoglobin level. A score of 8 or less corresponds to a 95% probability of safe discharge. The score was derived in a large UK-based multi-centre study (The Lancet, 2017) involving around 2,300 patients. It has not been internationally validated yet.
It is Free