This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Heavy rectal bleeding, dizziness or fainting is an emergency: call 911.
Who is safe to go home?
Acute lower gastrointestinal bleeding, usually bright red or maroon blood from the rectum, is a common reason for emergency visits, especially in older adults. Most bleeds stop on their own, often from diverticula or hemorrhoids, and many patients do not need to stay in hospital. The Oakland score, developed in 2017 from a UK audit of more than 2,000 patients, helps identify those who can be safely discharged and investigated as outpatients.
How the score is built
The score adds seven items, for a total of 0 to 35:
| Item | Points |
|---|---|
| Age | under 40: 0; 40 to 69: 1; 70 or more: 2 |
| Sex | female: 0; male: 1 |
| Previous admission for lower GI bleeding | no: 0; yes: 1 |
| Blood on digital rectal exam | no: 0; yes: 1 |
| Heart rate (per minute) | under 70: 0; 70 to 89: 1; 90 to 109: 2; 110 or more: 3 |
| Systolic blood pressure (mmHg) | under 90: 5; 90 to 119: 4; 120 to 129: 3; 130 to 159: 2; 160 or more: 0 |
| Hemoglobin (g/dL) | under 7: 22; 7 to 8.9: 17; 9 to 10.9: 13; 11 to 12.9: 8; 13 to 15.9: 4; 16 or more: 0 |
Note that a high blood pressure scores zero: the score rewards a stable circulation.
Reading the result
A score of 8 or less predicted about a 95% chance of a safe discharge, meaning no rebleeding, transfusion, intervention, readmission or death within 28 days. The British Society of Gastroenterology recommends that these patients can be discharged for urgent outpatient investigation, usually a colonoscopy. Above 8, admission is generally advised, and unstable patients need resuscitation and CT angiography.
Worked example
A 55-year-old man with no previous bleeding admission and no blood on rectal exam, a heart rate of 85, systolic pressure of 125 mmHg and hemoglobin of 12 g/dL scores 1 (age) + 1 (male) + 1 (heart rate) + 3 (blood pressure) + 8 (hemoglobin) = 14. He should be admitted, although he looks well; his moderate anemia drives the score up.
Limits
The score was not designed for upper GI bleeding (vomiting blood or black stools), for which the Glasgow-Blatchford score is used. It does not account for anticoagulants, frailty or social circumstances, which a clinician must weigh before sending anyone home.