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MELD-NaAssesses the severity of chronic liver diseaseChild-Pugh ScoreAssesses the prognosis of chronic liver disease, mainly cirrhosisFIB-4 IndexLiver fibrosis scoring indexAPRIAST to platelet ratio — liver fibrosisMaddrey's DFAlcoholic hepatitis severityGlasgow-BlatchfordUpper GI bleed risk stratificationGAHSGlasgow alcoholic hepatitis scoreMontreal IBDIBD classification — CD & UCMayo ScoreUlcerative colitis activityBISAP ScoreBedside index for severity of pancreatitisCLIF-SOFAOrgan failure scoring in cirrhosisAlcohol ContentStandard drinks & alcohol grams calculatorAARC-ACLFAcute-on-chronic liver failure gradePELD / CR ScorePediatric end-stage liver diseaseHarvey-BradshawCrohn's disease activity indexCTSICT severity index — pancreatitisRockall ScoreGI bleed rebleeding & mortality riskCAGEAlcohol use disorder screening (4 questions)MELD 3.0Updated MELD — sex-inclusive formulaAUDIT ScoreAlcohol use disorders identification testVOCAL-Penn ScorePost-operative mortality risk in cirrhosis surgery

Liver & Cirrhosis

17
ALBI GradeAlbumin-bilirubin liver function grade in HCCUKELD ScoreUK model for end-stage liver diseaseMELD-XIMELD excluding INR — for anticoagulated patientsWest Haven CriteriaHepatic encephalopathy gradingMilan CriteriaLiver transplant eligibility in hepatocellular carcinomaLI-RADS v2018 (CT/MRI)Liver observation category from size, APHE and major featuresBCLC StagingHepatocellular carcinoma stage and treatment allocationSimplified AIH CriteriaSimplified criteria for autoimmune hepatitisRevised Original AIH ScoreIAIHG 1999 comprehensive autoimmune hepatitis scoreSAAGSerum-ascites albumin gradient — cause of ascitesR FactorHepatocellular vs cholestatic pattern in liver injuryCLIF-C ACLFMortality prediction in acute-on-chronic liver failureKing's College CriteriaTransplant criteria in acute liver failureGALAD ScoreHCC detection from gender, age, AFP-L3, AFP and DCPMetroticket 2.0AFP-adjusted up-to-seven for HCC transplant eligibilityRUCAMCausality in drug- and herb-induced liver injuryBaveno VII CriteriacACLD, CSPH and sparing screening endoscopy

Fibrosis & MASLD

8
NAFLD Fibrosis ScoreAdvanced fibrosis probability in MASLD/NAFLDBARD ScoreBMI, AST/ALT ratio, diabetes — MASLD fibrosisFatty Liver IndexPredicts hepatic steatosis from routine labsFibrotic NASH Index (FNI)At-risk NASH probability from AST, HbA1c and HDLNAFLD Activity Score (NAS)Histologic activity grade — steatosis, inflammation, ballooningMEFIB IndexMRE + FIB-4 rule for significant fibrosis (≥F2) in MASLDFAST ScoreFibroScan-AST — at-risk NASH from LSM, CAP and ASTSAFE ScoreSteatosis-Associated Fibrosis Estimator for MASLD in primary care

Pancreas & Biliary

8
Ranson's CriteriaAcute pancreatitis severity at 48 hoursGlasgow-Imrie CriteriaAcute pancreatitis severity — the PANCREAS criteriaHAPSHarmless acute pancreatitis scoreTokyo Guidelines — CholangitisTG18 diagnosis and severity grade for acute cholangitisTokyo Guidelines — CholecystitisTG18 diagnosis and severity grade for acute cholecystitisBiliary Pain (Rome IV)Rome IV — defining biliary-type pain before interventionFunctional Pancreatic SODRome IV — pancreatic sphincter of Oddi disorderRevised Atlanta ClassificationAcute pancreatitis severity — mild, moderately severe, severe

IBD

9
Truelove & Witts CriteriaAcute severe ulcerative colitis — admission decisionUCEISUlcerative colitis endoscopic index of severitySCCAISimple clinical colitis activity index — symptoms onlyCDAICrohn's disease activity index — the trial standardSES-CDEndoscopic severity in Crohn's diseasePUCAIPaediatric ulcerative colitis activity indexTravis (Oxford) CriteriaDay 3 colectomy risk in acute severe ulcerative colitisHo IndexDay 3 steroid failure risk in acute severe ulcerative colitisRutgeerts ScorePostoperative Crohn's recurrence at ileocolonoscopy

GI Bleeding

7
EVendo ScorePredicts oesophageal varices needing treatmentForrest ClassificationPeptic ulcer bleeding — rebleeding risk at endoscopyAIMS65 ScoreUpper GI bleed mortality — five bedside criteriaOakland ScoreSafe-discharge risk for acute lower GI bleedingABC ScoreAge, blood tests, comorbidities — GI bleed mortalitySarin ClassificationEndoscopic classification of gastric varicesEGUS (Gastric Ulcer)Malignancy risk in a gastric ulcer, and who needs repeat endoscopy

Alcohol

2
ABIC ScoreAge, bilirubin, INR, creatinine — alcoholic hepatitisLille ModelSteroid response at day 7 in alcoholic hepatitis

Upper GI

4
Chicago Classification v4.0Oesophageal motility pattern from high-resolution manometryLA Classification (Oesophagitis)Los Angeles grade A–D for erosive oesophagitisPrague C & M CriteriaCircumferential and maximal extent of Barrett's oesophagusEREFS (Eosinophilic Oesophagitis)Endoscopic reference score — oedema, rings, exudates, furrows, stricture

Colorectal

3
Boston Bowel Prep ScaleColonoscopy preparation adequacy by segmentStool Osmotic GapOsmotic vs secretory diarrhoea from stool electrolytesATLAS Score (C. difficile)Predicted response to therapy in Clostridioides difficile infection

Functional GI

37
Bristol Stool ScaleStool form types 1–7 and colonic transitRome IV Criteria for IBSIrritable bowel syndrome diagnosis and subtypeFunctional ConstipationRome IV — two of six items, IBS excludedOpioid-Induced ConstipationRome IV — constipation tied to opioid therapyFunctional DiarrhoeaRome IV — loose stools without predominant painFunctional Bloating / DistensionRome IV — bloating without other bowel disorder criteriaUnspecified Functional Bowel DisorderRome IV — bowel symptoms fitting no other categoryCentrally Mediated Abdominal Pain (CAPS)Rome IV — continuous pain unrelated to gut eventsNarcotic Bowel SyndromeRome IV — opioid-induced hyperalgesia of the gutFaecal Incontinence (Rome IV)Rome IV — the criteria, and why nobody is askedFunctional Anorectal PainLevator ani, unspecified pain and proctalgia fugaxFunctional Defecation DisordersRome IV — dyssynergia and inadequate propulsionInfant RegurgitationRome IV — the happy spitter, and the alarm features that rule it outInfant ColicRome IV — recurrent unexplained crying in a well infant under 5 monthsInfant DyscheziaRome IV — straining before a soft stool, and why not to intervenePaediatric Functional ConstipationRome IV — two of six over one month, with overflow soiling as a criterionToddler's DiarrhoeaRome IV functional diarrhoea of childhood — painless, thriving childPaediatric Cyclic Vomiting SyndromeRome IV — both age bands, with different criteria for eachPaediatric Rumination SyndromeRome IV — infant and child/adolescent criteriaFunctional Nausea & Vomiting (Children)Rome IV — two separate disorders that can be met togetherAerophagiaRome IV — distension that increases through the dayPaediatric Functional DyspepsiaRome IV — four times a month, with PDS and EPS subtypingPaediatric Irritable Bowel SyndromeRome IV — plus the constipation clause clinicians missAbdominal MigraineRome IV — stereotypical incapacitating episodes weeks apartFunctional Abdominal Pain — NOSRome IV — the residual category, reached after the other threeNonretentive Faecal IncontinenceRome IV — soiling without retention, where laxatives make it worseFunctional DyspepsiaRome IV — with PDS and EPS subtypingRumination SyndromeRome IV — effortless regurgitation without retchingCyclic Vomiting SyndromeRome IV — stereotypical episodic vomitingCannabinoid HyperemesisRome IV — CVS pattern relieved by cannabis cessationChronic Nausea & VomitingRome IV — chronic nausea and vomiting syndromeBelching DisordersRome IV — supragastric vs gastric belchingFunctional HeartburnRome IV — heartburn with normal acid exposureReflux HypersensitivityRome IV — normal acid exposure, positive symptom associationFunctional Chest PainRome IV — non-cardiac, non-reflux chest painGlobusRome IV — painless lump-in-throat sensationFunctional DysphagiaRome IV — dysphagia with normal endoscopy and manometry
  1. Calculators
  2. /
  3. Oakland Score
GI Bleeding

Oakland Score

Safe-discharge risk for acute lower GI bleeding

0 points if ≤ 39, 1 if 40–69, 2 if ≥ 70.

Male scores 1 point.

A prior LGIB admission scores 1 point.

Blood on rectal examination scores 1 point.

0 if ≤ 69, 1 if 70–89, 2 if 90–109, 3 if ≥ 110.

5 if 50–89, 4 if 90–119, 3 if 120–129, 2 if 130–159, 0 if ≥ 160.

22 if 3.6–6.9, 17 if 7.0–8.9, 13 if 9.0–10.9, 8 if 11.0–12.9, 4 if 13.0–15.9, 0 if ≥ 16.

Seven variables from the presentation of an acute lower GI bleed. A score of 8 or below identifies patients who can be considered for safe discharge.

When to use
Use it in the emergency department or acute assessment unit for an adult presenting with acute lower gastrointestinal bleeding, once the basic observations and a full blood count are back, to decide between admission and discharge with outpatient follow-up. Its purpose is to identify the substantial group of self-limiting bleeds that do not need hospital care, and so to spare beds and investigations while keeping the higher-risk minority in. It is not designed for upper GI bleeding (use Glasgow-Blatchford there), it assumes haemodynamic resuscitation has been started, and it complements rather than replaces clinical judgement.
Why use it
Because most acute lower GI bleeding stops on its own, yet a large share of these patients are admitted by default, and Oakland was derived precisely to make the discharge decision defensible and consistent. It was built and validated on nationwide audit data with a hard composite of clinically important adverse outcomes, so a low score carries real evidence behind it rather than gestalt. Using it shifts the question from 'does this bleeding worry me?' to 'is this patient in the validated low-risk group?', which is a more reproducible basis for sending someone home.
Formula, evidence and interpretation

About the Oakland Score for Safe Discharge After Lower GI Bleeding

The Oakland score decides whether a patient with acute lower gastrointestinal bleeding can be safely discharged rather than admitted. It combines seven items available at presentation — age, sex, previous LGIB admission, blood on rectal examination, heart rate, systolic blood pressure and haemoglobin — into a score from 0 to 35, with haemoglobin the heaviest term. A score of 8 or below identifies a low-risk patient with roughly a 95% probability of avoiding an adverse outcome (rebleeding, transfusion, intervention, in-hospital death or 28-day readmission), supporting outpatient management. It is the lower-GI counterpart to the Glasgow-Blatchford score, and it is a triage-to-discharge tool, not a mortality score.

On this page

  • Formula
  • Interpreting the result
  • Inputs
  • What it returns
  • How it is calculated
  • Facts & figures
  • Evidence
  • How it compares
  • Pearls & pitfalls
  • Critical actions
  • Why it exists
  • About the creator
  • Limitations
  • If you are the patient
  • FAQ
  • Related calculators
  • References

Formula

Oakland = age points + sex points + prior-LGIB points + rectal-exam points + heart-rate points + systolic-BP points + haemoglobin points
age points
0 (≤39), 1 (40–69), or 2 (≥70).
sex points
1 if male, else 0.
prior-LGIB points
1 if a previous LGIB admission, else 0.
rectal-exam points
1 if blood found on DRE, else 0.
heart-rate points
0 (≤69), 1 (70–89), 2 (90–109), 3 (≥110).
systolic-BP points
5 (50–89), 4 (90–119), 3 (120–129), 2 (130–159), 0 (≥160).
haemoglobin points
22 (3.6–6.9), 17 (7.0–8.9), 13 (9.0–10.9), 8 (11.0–12.9), 4 (13.0–15.9), 0 (≥16) g/dL.
  • Haemoglobin dominates the score — a severe anaemia alone contributes 22 of the 35 possible points, so the discharge decision is largely, though not only, a haemoglobin decision.
  • The safe-discharge threshold is 8 or below, inclusive.
  • The original derivation reported haemoglobin in g/L; the thresholds here are the equivalent g/dL values used in most implementations.

Interpreting the result

Treat a score of 8 or below as the green light: the patient falls in the low-risk group, with about a 95% probability of no adverse outcome, and can usually be discharged with outpatient follow-up provided the clinical picture agrees. A score above 8 does not meet the safe-discharge threshold and favours admission for observation and investigation. Some centres extend the cut-off to 10 to enlarge the discharge-eligible group at a modest cost in sensitivity; this widens throughput but should be validated locally before adoption. Whatever threshold is used, the score supports the decision — it does not overrule ongoing bleeding, an unstable patient or a clinician's concern.

ScoreBandWhat it meansAction
0–8Low risk — safe discharge≈ 95% probability of no adverse outcomeConsider discharge with outpatient follow-up, alongside clinical judgement
9–35Not low riskHigher probability of rebleeding, transfusion, intervention, death or readmissionAdmit for observation, resuscitation and investigation

What the Oakland Score needs (7 inputs)

Age
0 points if 39 or under, 1 point at 40–69, 2 points at 70 or over.
Sex
1 point for male, 0 for female — men had a higher risk of adverse outcome in the derivation cohort.
Previous LGIB admission
1 point for a prior hospital admission with lower GI bleeding, 0 if none.
Digital rectal examination
1 point if blood is found on rectal examination, 0 if not — a simple bedside marker of ongoing or recent bleeding.
Heart rate
0 points if 69 or under, 1 at 70–89, 2 at 90–109, 3 at 110 or over.
Systolic blood pressure
5 points at 50–89 mmHg, 4 at 90–119, 3 at 120–129, 2 at 130–159, 0 at 160 or over — the score penalises hypotension, so lower pressures earn more points.
Haemoglobin
The heaviest term: 22 points at 3.6–6.9 g/dL, 17 at 7.0–8.9, 13 at 9.0–10.9, 8 at 11.0–12.9, 4 at 13.0–15.9, 0 at 16 or above.

What it returns

Oakland score (0–35)
The sum of the seven items. Higher scores indicate a higher risk of an adverse outcome.
Discharge band
≤ 8 supports safe discharge; above 8 does not meet the threshold and favours admission.

How it is calculated

Oakland is a points score derived by logistic regression on a national audit of acute lower GI bleeding, with the coefficients converted to integer weights. The outcome it was fitted against is a composite of clinically meaningful events — rebleeding, red-cell transfusion, therapeutic intervention (endoscopic, radiological or surgical), in-hospital death and readmission within 28 days — so the score is calibrated to the exact bundle of things that would make discharge unsafe. Because anaemia and haemodynamic compromise are the strongest signals of a bleed that will not behave, haemoglobin and the vital-sign terms carry most of the weight, while age, sex, prior bleeding and rectal findings fine-tune the estimate.

Facts & figures

Point allocation by variable
VariableCategories → points
Age≤39: 0 · 40–69: 1 · ≥70: 2
SexFemale: 0 · Male: 1
Previous LGIB admissionNo: 0 · Yes: 1
Rectal examNo blood: 0 · Blood: 1
Heart rate≤69: 0 · 70–89: 1 · 90–109: 2 · ≥110: 3
Systolic BP (mmHg)50–89: 5 · 90–119: 4 · 120–129: 3 · 130–159: 2 · ≥160: 0
Haemoglobin (g/dL)3.6–6.9: 22 · 7.0–8.9: 17 · 9.0–10.9: 13 · 11.0–12.9: 8 · 13.0–15.9: 4 · ≥16: 0

Total range 0–35; the safe-discharge threshold is ≤ 8.

Evidence

Derivation and validation — UK national audit

2017 · n = 2,336

Derived from a UK-wide audit of acute lower gastrointestinal bleeding admissions and validated internally, using a composite adverse-outcome endpoint of rebleeding, transfusion, therapeutic intervention, in-hospital death and 28-day readmission.

The model discriminated adverse outcomes with an area under the ROC curve around 0.84. A threshold of 8 or below identified low-risk patients suitable for discharge with high sensitivity for excluding adverse outcomes.

US external validation

2020

External validation in a US cohort of adults with acute lower GI bleeding, testing the ≤ 8 threshold for safe discharge.

At a threshold of 8 or below the score was highly sensitive for excluding adverse outcomes (around 98%) with correspondingly modest specificity, and discriminated adverse outcomes with an AUROC near 0.87 — supporting its use to identify low-risk patients across health systems.

How it compares

Oakland Score vs Glasgow-Blatchford Score

They are territory-matched siblings: Glasgow-Blatchford identifies low-risk upper GI bleeds for discharge, Oakland does the same job for lower GI bleeds — use the one that matches the suspected source.

Both were built to find patients who can avoid admission, both lean heavily on haemoglobin and haemodynamics, and both are deliberately tuned for high sensitivity. The difference is anatomical: Glasgow-Blatchford was derived in upper GI bleeding and includes urea, while Oakland was derived in lower GI bleeding and adds a rectal-examination finding and prior-LGIB history. Applying the wrong one to the wrong territory is the main pitfall.

Open the Glasgow-Blatchford Score calculator →

Oakland Score vs ABC Score

Different endpoints: Oakland answers 'can this lower GI bleed go home?', while ABC answers 'what is this patient's 30-day mortality?' across both upper and lower bleeding — pick the score whose question matches the decision.

ABC spans upper and lower GI bleeding and predicts death, driven by age, comorbidity and organ dysfunction. Oakland is confined to lower GI bleeding and predicts a composite adverse outcome centred on the discharge decision. A young patient with a self-limiting bleed can be Oakland-low and ABC-low together, but the two are measuring different things and are best used side by side rather than interchangeably.

Open the ABC Score calculator →

Pearls & pitfalls

  • Haemoglobin dominates the score — a markedly low haemoglobin can push a patient over the threshold on its own, which is clinically appropriate for a bleed.
  • It is a discharge score for lower GI bleeding, not a mortality score and not for upper GI bleeding; for suspected upper GI bleeding use Glasgow-Blatchford.
  • The rectal-examination item requires an actual DRE — omitting it and assuming 'no blood' will underscore the patient.
  • Score the presenting, post-initial-resuscitation values; the systolic BP and heart-rate terms reflect the patient in front of you.
  • The extended ≤ 10 threshold discharges more patients but at some cost in sensitivity, and should be validated in the local population before it is adopted.
  • A low score does not override active bleeding, haemodynamic instability, significant comorbidity or a poor social situation — clinical judgement retains a veto.

Critical actions

  • Complete a digital rectal examination and a full blood count before scoring — both feed directly into the result.
  • Discharge Oakland ≤ 8 patients with clear safety-netting and outpatient follow-up rather than routine admission, where the clinical picture agrees.
  • Admit patients scoring above 8 for observation, resuscitation and investigation of the bleeding source.
  • Resuscitate and reassess an unstable patient before relying on the score; it assumes initial resuscitation has occurred.
  • Document that the score supported the decision, and that ongoing bleeding or instability was considered independently of the number.

Why this score exists

Oakland and colleagues designed the score around a decision rather than a diagnosis: the question was not how severe the bleed is in the abstract but whether this particular patient can go home safely. That framing explains the choice of a composite outcome built from the events that would make discharge a mistake, and the deliberate emphasis on haemoglobin and haemodynamics, which are the values that separate a self-limiting bleed from one that will declare itself. The threshold of 8 was chosen to keep sensitivity high, accepting lower specificity, because the cost of wrongly discharging a serious bleed outweighs the cost of a cautious admission.

About the creator

  • Kathryn Oakland

    First author, 2017 derivation study

    Derived the score from a UK national audit of lower gastrointestinal bleeding to identify patients safe for outpatient management.

  • Gary S. Collins

    Senior author

    Provided the prediction-model methodology; he is a leading author of the TRIPOD reporting standard for such models.

Limitations

  • It applies only to acute lower gastrointestinal bleeding, not upper GI bleeding.
  • Specificity at the ≤ 8 threshold is low, so it errs towards caution and admits some patients who would have done well.
  • It predicts a composite adverse outcome rather than mortality specifically, so it is not a prognostic death score.
  • Haemoglobin's dominance means a chronic anaemia unrelated to the acute bleed can inflate the score.
  • It was derived largely in UK audit populations, and although externally validated, local calibration is worth checking before adopting an extended threshold.

If you are the patient

The Oakland score helps doctors decide whether someone who has had bleeding from the lower bowel (bright or dark blood from the back passage) needs to stay in hospital or can safely go home with follow-up. It adds up seven things measured when you arrive — your age, sex, whether you have been admitted for this before, whether there is blood when the doctor examines the back passage, your pulse, your blood pressure and, most importantly, your blood count (haemoglobin) — to give a score out of 35. A score of 8 or less means you are in the low-risk group, with about a 95% chance of no serious problem, so going home is usually reasonable. A higher score means it is safer to be admitted for a closer look. It is about whether it is safe to go home, not about longer-term risk, and the doctor will always weigh it against how you actually look and feel.

Frequently asked questions

What is the Oakland score?#

The Oakland score is a seven-item tool for acute lower gastrointestinal bleeding that predicts the risk of an adverse outcome and identifies patients who can be safely discharged. It uses age, sex, previous LGIB admission, rectal-examination findings, heart rate, systolic blood pressure and haemoglobin, scoring 0 to 35.

What Oakland score is safe for discharge?#

A score of 8 or below marks a low-risk patient with roughly a 95% probability of avoiding an adverse outcome, supporting discharge with outpatient follow-up. Some services extend the threshold to 10 to discharge more patients, at a small cost in sensitivity.

Is the Oakland score for upper or lower GI bleeding?#

Lower GI bleeding. It was derived and validated specifically in acute lower gastrointestinal bleeding. For upper GI bleeding, the equivalent safe-discharge tool is the Glasgow-Blatchford score.

Which variable matters most in the Oakland score?#

Haemoglobin. It carries up to 22 of the 35 possible points, so a severe anaemia contributes most of the score on its own — appropriately, since a low haemoglobin is the strongest signal of a significant bleed.

How is the Oakland score different from the Glasgow-Blatchford score?#

Both find low-risk patients who can avoid admission, but Glasgow-Blatchford is for upper GI bleeding and includes urea, while Oakland is for lower GI bleeding and adds a rectal-examination finding and previous-LGIB history. Choose the score that matches the suspected bleeding source.

Does a low Oakland score guarantee it is safe to go home?#

No. It identifies a low-risk group and supports the discharge decision, but it does not override active bleeding, an unstable patient, significant comorbidity or clinical concern. It is a decision aid, not a rule that replaces judgement.

Related calculators

  • Glasgow-Blatchford — Upper GI bleed risk stratification
  • ABC Score — Age, blood tests, comorbidities — GI bleed mortality
  • Rockall Score — GI bleed rebleeding & mortality risk
  • ATLAS Score (C. difficile) — Predicted response to therapy in Clostridioides difficile infection

References

Original / primary reference

  1. Oakland K, Jairath V, Uberoi R, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(9):635-643.

Validation

  1. Oakland K, Kothiwale S, Forehand T, et al. External Validation of the Oakland Score to Assess Safe Hospital Discharge Among Adult Patients With Acute Lower Gastrointestinal Bleeding in the US. JAMA Netw Open. 2020;3(7):e209630.

Clinical practice guidelines

  1. Oakland K, Chadwick G, East JE, et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut. 2019;68(5):776-789.
  2. Sengupta N, Feuerstein JD, Jairath V, et al. Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. Am J Gastroenterol. 2023;118(2):208-231.

Further reading

  1. Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016;111(4):459-474.

Last updated July 30, 2026. Clinical knowledge base written and curated by GastroAGI Team from primary medical literature.

Written from primary literature and not yet independently clinically reviewed.

For use by qualified healthcare professionals. This calculator supports clinical judgement and does not replace it.