Whiteway James, Yim Stephanie, Leong Natalie, Shah Ankur
Department of General Surgery, East Kent Hospitals University NHS Foundation Trust William Harvey Hospital, Ashford, GBR.
Department of General Surgery, East Cheshire NHS Trust Macclesfield District General Hospital, Macclesfield, GBR.
Cureus. 2024 Mar 4;16(3):e55497. doi: 10.7759/cureus.55497. eCollection 2024 Mar.
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.
引言 下消化道出血（LGIB）定义为在Treitz韧带以外的胃肠道存在出血点。最常见的病因包括憩室出血、肿瘤和结肠炎。英国国家卫生与临床优化研究所（NICE）没有关于LGIB患者安全出院的指南。本研究的目的是调查英国胃肠病学会（BSG）指南建议的奥克兰评分在威廉·哈维医院LGIB患者中的有效性和安全性。方法 本回顾性研究纳入了2023年1月至12月因急诊或住院转诊而出现LGIB的患者。数据从患者的Sunrise病历中提取。计算每位患者的奥克兰评分。评分≤8分者被认为可安全出院；评分较高者被认为不适合出院。调查患者的入院、出院情况以及不良结局，如再次就诊、输血或进一步干预。无不良结局的患者被认为实现了安全出院。计算奥克兰评分与不良结局（以及因此的安全出院）的受试者工作特征曲线下面积（AUROC）。结果 共纳入123例患者。这些患者导致医院共出现144次LGIB情况。29例患者的奥克兰评分为≤8分；21例（72.4%）最初出院，其中4例（19.0%）再次就诊，8例（27.6%）入院，不过这些患者均未出现任何不良结局。因此，对于评分≤8分的患者，25例（86.2%）被认为实现了安全出院。共有115例患者评分>8分；43例（37.4%）最初出院，72例（62.6%）入院，41例（35.7%）经历了至少一项不良结局，包括16例（13.9%）再次就诊、21例（18.3%）输血、3例（2.6%）手术干预和1例（0.9%）内镜止血。在115例评分>8分的病例中，74例（64.3%）被认为实现了安全出院。安全出院的AUROC为0.84。结论 奥克兰评分似乎是一种安全可靠的工具，可用于识别无需医院干预即可安全出院回家的LGIB患者。然而，由于许多评分较高的患者未出现不良结局，因此需要进一步研究来评估评分>8分是否可用。
