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Richard P. Maguire2, Anthony DeNardo1, Arrhchanah Balachandran2, Sneha John*1
1Gastroenterology, Gold Coast University Hospital, Brisbane, Queensland, Australia; 2Surgery, Gold Coast University Hospital, Southport, Queensland, Australia

Background and Aims:
Acute lower intestinal bleeding (ALIB) has variable presentation ranging from minor haemorrhoidal bleeding to life threatening diverticular haemorrhage. Risk stratification of patients and early identification of high risk patients requiring urgent intervention is challenging. There is paucity of evidence to support a single clinical tool to identify patients who may require early and aggressive intervention. The Strate score was developed as a clinical prediction tool for severe ALIB. More recently, the use of the Glasgow Blatchford Score (GBS) has also been proposed. The aim of our study was to compare the use of the Strate score and GBS to assess severity of ALIB in our patient cohort and the identification of high risk patients requiring urgent therapeutic intervention.
This was a retrospective cohort study in a single tertiary hospital. Patients who presented with ALIB between January 2015 and September 2017 were identified from a hospital database. Admission data was analysed to calculate Strate score and GBS. They were then divided into low, moderate and high risk groups based on these scores. Need for any intervention and details of interventions required in each subgroup were then collated .Any complications that occurred were also recorded.
198 patients were identified in the study period with a diagnosis of ALIB. 55 were excluded due to insufficient data to complete the analysis. 143 patients were then divided into low, moderate and high risk groups with the Strate score and GBS. There were 62 females and 81 males in the cohort with a mean age of 73 years. The Strate score identified 27 patients (18%) as high risk. Of these patients, 10 underwent angiography and embolisation for active bleeding and 1 patient had attempted colonoscopic intervention prior to angiography (37%). In comparison, the low risk group did not require any urgent interventions or therapy. GBS identified 61 patients as high risk (GBS>6) with a therapeutic intervention rate of 19%. In comparison, in the low risk group (GBS 0-1) only 1 patient required any intervention. Detailed results are in table below. 2 patients from the high risk group underwent emergency surgery for ischaemia complicating successful embolisation of diverticular haemorrhage. Only 20% of our patients underwent inpatient colonoscopy with no significant endoscopic intervention required.

Conclusion: The Strate and GBS scoring systems are useful tools to identify high risk individuals requiring early intervention in ALIB. They also help identify low risk patients who may only require outpatient management. However,the management of patients in the moderate risk group is less well defined. Further prospective outcome studies are required to determine the ideal risk predictor tools and management pathways for all patients with ALIB.

Strate Score
Risk stratification with Strate
Low risk(0)Moderate risk(1-3)High risk(>3)
Number of patients
Therapeutic intervention rate in %01137

GBS risk stratification
GBS stratificationLow risk(0-1)Moderate risk(2-6)High risk(>6)
Number of patients315161
Therapeutic intervention rate in %31919

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