AIMS65 is the new standard of care for risk stratification in upper GI bleeding

An Australian prospective study has provided further support for the use of the simple AIMS65 risk stratification score for patients presenting with upper GI bleeding, according to Melbourne clinicians.

Dr Marcus Robertson, a gastroenterologist at Monash Health, Melbourne, told Digestive Diseases Week (DDW) 2018 in Washington DC that the score was not only easier to use than current tools such as the Glasgow-Blatchford (GBS) and Rockall scores, but had also been shown to be more accurate in predicting patient mortality.

Unlike other risk stratification scores, AIMS65 is based on information available prior to endoscopy such as age, mental state, albumin and INR levels, he noted

In a ‘real world’ study of 570 patients presenting with upper GI bleeding to three Australian in 2016 and 2017, AIMS65 proved to be superior to GBS (Area Under ROC Curve 0.89 vs 0.67, p<0.0001) and both pre-Rockall and Rockall scores (AUROC 0.76, p=0.0004 and 0.79, p=0.0059) in predicting inpatient mortality.

An AIMS56 cut-off score of 3 had maximal sensitivity and specificity to define high and low risk groups (mortality 1.3 % vs. 20.4%). AIMS65 was also superior to all other scores in predicting length of stay. All scores were equivalent in predicting the need for ICU admission.

Dr Robertson said the AIMS65 score had previously been supported by retrospective study evidence and now there was more robust data from a large prospective study that it had superior accuracy to other pre- and post-endoscopy scores in as a risk assessment tool for upper GI bleeding

“I believe it should be the new standard of care for risk stratification in patients presenting with upper GI bleeding – it can facilitate early identification of patients with the highest risk of mortality,” he told the meeting.

“If we are to lower the mortality rate for upper GI bleeding I would suggest that early identification of patients at high risk of bleeding is critical to allow early intervention.”

“Importantly this score is very easy to calculate and can be calculated on presentation to the emergency department without the need for endoscopic findings. It’s applicable to all patients including those with variceal and non-variceal bleeding,” Dr Robertson noted.

The next step is to have prospective trials to see whether early identification of high risk patients can improve outcomes, he suggested.

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