Clinical application of AIMS65 score to predict outcome in patients with acute upper gastrointestinal bleeding

BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department. The current available scores are complex and have not been widely used in clinical practice. AIMS65 score is a simple score that can be used to risk stratify patients with AUGIB. METHODS: This was a descriptive cross-sectional study done at a single tertiary centre, NAMS, Bir Hospital among the patients presenting with AUGIB from August 2018 to January 2019. AIMS65 scores were calculated in patients presenting with acute UGIB by allotting 1 point each for albumin level < 3g/dl, INR > 1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. RESULTS: A total of 84 patients consisting of 68 males and 16 females were enrolled in our study, with age ranging from 27 to 80 years. ICU admission, endoscopic therapy and blood transfusion were required in 22,44 and 49 patients respectively. In-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission were higher in those with AIMS65 score ≥ 2 showing statistically significant positive association (p=0.000). CONCLUSION: AIMS65 score is a simple non-endoscopic risk score that can be applied in patients of acute upper gastrointestinal bleeding to risk stratify and to predict in-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission.

P-EGS18 The outcomes of upper gastrointestinal bleeds with unsuccessful endoscopy in a district hospital with no interventional radiology

Background Acute upper gastrointestinal bleeding (UGIB) is a common emergency estimated to occur in 80 to 150 out of 100,000 people each year. First line management is endoscopy and pharmacological but those who fail this can pose a challenge. Current NICE guidelines recommend repeat endoscopy to patients who re-bleed, those unstable consider interventional radiology (IR) or emergency surgery. The estimated mortality rate is approximately 10%. This study was conducted to review our current surgical outcomes and whether referral for IR is appropriate and could reduce mortality. Methods Retrospective study of 11 patients who underwent surgery for refractory non- variceal UGIB between November 2015 and March 2021 with a mean age of 61. Data was collected from the electronic records. Results All patients underwent an emergency laparotomy, 82% had an ASA of 4 the remainder ASA 3, a mean NELA mortality of 31.1% and a mean Blatchford 11.1. The initial OGD was performed on the day of admission in 54% of patients. 45% during initial OGD became hemodynamically unstable and transferred to theatre, one patient re-bleed 3 days after and taken to theatre the remainder (45%) re-bleed and had a 2nd OGD. 2 patients unstable during OGD went to theatre, 3 re-bleed within 24hrs 1 within 48hrs and taken to theatre. Mortality rate was 27%, complication rate 45%, mean LOS 24.6. Conclusions These findings highlight the high rate of morbidity and mortality associated with surgical treatment for UBIB. A small number of cases occurred over 7 years requiring surgical intervention,45% had two OGD’s and 9% went on to have a 3rd. Was there a window of opportunity to use IR if it were available. Recent studies have shown that transcatheter arterial embolization is safer than surgical intervention in the high risk patient population and has a lower 30-d mortality rate.