EP127 - Audit on Acute PR Bleed Admissions to the Surgical Assessment Unit and the Use of the Shock Index and Oakland Score

Abstract

Abstract Aims The British Society of Gastroenterology recommend using the Shock Index (SI) and Oakland Score (OS) as an assessment tool to safely discharge patients presenting with acute PR bleeding. This study audited the use of these scores in the surgical assessment unit (SAU) of a large teaching hospital. Methods A retrospective list of patients presenting to SAU in October and November 2023 and their main presenting concerns were sought. Patients presenting with PR bleeding were identified and their notes reviewed. Data including age, sex and use of OS and SI were retrieved. OS and SI was calculated. A threshold of ≤1 for SI and ≤8 for OS was used for safe discharge. A threshold of ≤8 for OS equates to a 95% safe discharge probability. Results 44 PR bleed admissions were identified but 7 excluded due to known cause. 18/37 were male and 19/37 females. The median age was 53, with interquartile range 33-76. On surgical clerking, 0/37 patients had SI documented and 1/37 patients had OS calculated. 3 further patients were excluded due to lack of clinical information. No patient had SI over 1. 12/34 (35%) patients were managed appropriately. OS (threshold ≤8) identified 20/34 (58.9%) were incorrectly discharged. 2 other patients inappropriately had a CTA: one could have been safely discharged and the other managed with inpatient endoscopy. Conclusion Currently, discharges of PR bleed presentations to General Surgery does not follow national guidance. The validated OS should be used to provide a safe and objective tool for discharge.