Am Fam Physician. 2024;109(3):284-285
Author disclosure: No relevant financial relationships.
Key Points for Practice
• Risk stratification tools, such as the Oakland score, have some evidence of helping determine which patients with lower GI bleeding do not need hospitalization, but clinical judgment is still needed.
• For hemodynamically significant lower GI bleeding, CT angiography can accurately locate the bleeding source.
• For hemodynamically stable patients, with or without continued lower GI bleeding, performing colonoscopy within 14 days of presentation is as effective as performing it within 24 hours.
• Transcatheter embolization within 90 minutes of positive CT angiography results can stop bleeding 98% of the time, although 30-day mortality is 13%.
From the AFP Editors
Acute lower gastrointestinal (GI) bleeding, with hematochezia or bright red blood from the rectum, is cause for more than 100,000 hospital admissions annually. The American College of Gastroenterology (ACG) has published updated guidelines for the management of acute lower GI bleeding.
Risk Stratification
Risk stratification tools such as the Oakland score (https://www.mdcalc.com/calc/10042/oakland-score-safe-discharge-lower-gi-bleed) can be used to assist physicians in determining which patients may be suited for outpatient management. The Oakland score and other similar tools have demonstrated small-scale validity without randomized controlled trials or large-scale data verification. Physicians should primarily use clinical judgment when risk-stratifying patients with lower GI bleeding.
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