Assessment of Severity

BLEED Classification System

B – ongoing Bleeding,

L – Low systolic blood pressure

E – Elevated prothrombin time

E – Erratic mental status

D – unstable comorbid Disease.

There is extensive literature regarding risk stratification of upper GI bleeds, such as the Rockall score which is well validated and widely used. However, there is little information available in the literature for risk stratification of lower GI bleeds.

As most episodes of lower GI bleeding settle spontaneously, the early identification of high risk patients will allow for a more selective delivery of urgent therapeutic interventions.

One study developed the BLEemergency department classification system which allows the triage of patients into high or low risk groups of adverse in-hospital outcome (recurrent haemorrhage, need for surgery to control bleeding and death) [12].Another study developed the BLEED classification system [1]. Any patient with any of the criteria in tables above were deemed to be high risk.

Note none of these classification systems are well validated or in common use

Learning bite

Despite the fact that there is no well validated risk classification system, any patient with haemodynamic instability is at high risk for severe bleeding