Clinical utility of the Oakland score in rectal bleeding: Implications for admission decisions and cost efficiency

BACKGROUND: Rectal bleeding is a frequent cause of emergency admissions, yet objective criteria for hospitalization remain limited. The Oakland Score was developed to identify low-risk patients suitable for outpatient management. METHODS: This retrospective single-center study analyzed 346 patients presenting with rectal bleeding between 2015 and 2025. Patients were categorized as low-risk (Oakland ≤ 8, n = 142) or high-risk (Oakland ≥ 8, n = 204). Clinical parameters, transfusion, tranexamic acid (TXA) use, and total hospital costs were compared. RESULTS: High-risk patients were older (64.2 ± 14.2 vs 52.4 ± 14.1 years, p < 0.001), had lower hemoglobin (10.6 ± 2.2 vs 12.6 ± 1.9 g/dL, p < 0.001), lower systolic pressure (116.1 ± 17.0 vs 124.3 ± 15.2 mmHg, p < 0.001), and higher heart rate (92.5 ± 14.1 vs 83.2 ± 11.6 bpm, p < 0.001). Hospital admission (91.2% vs 40.8%), transfusion (35.3% vs 5.6%), and TXA use (73.5% vs 28.2%) were significantly greater in high-risk patients (all p < 0.001). The Oakland Score correlated positively with total cost (r = 0.55, p < 0.001) and length of stay (r = 0.52, p < 0.001). ROC analysis showed excellent discrimination for hospital admission (AUC = 0.86, p < 0.001). CONCLUSION: The Oakland Score reliably predicts both clinical severity and healthcare burden in patients presenting with rectal bleeding. Integrating this simple and objective tool into emergency department protocols can help physicians identify low-risk patients who may be safely discharged, thereby reducing unnecessary hospitalizations, optimizing resource use, and improving overall cost-effectiveness of care.