Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The AIMS65 Score is a tool designed to assess the risk of in-hospital mortality for patients experiencing upper gastrointestinal bleeding. This assessment is based on evaluating five specific factors or clinical criteria, each contributing to the total score:

- Albumin level less than 3 g/dL (30 g/L)
- INR (International Normalized Ratio) greater than 1.5
- Presence of altered mental status
- Systolic blood pressure less than or equal to 90 mmHg
- Age 65 years or older

For each criterion met, a score of 1 is assigned. If any of these criteria aren't met, the score for that factor is 0. Once all the criteria are evaluated, the scores are summed to provide a total score ranging from 0 to 5. This total reflects the patient's risk of in-hospital mortality, with interpretation as follows:

- A total score of 0 correlates to a 0.3% risk of in-hospital mortality.
- A score of 1 indicates a 1.2% risk.
- A score of 2 corresponds to a 2.8% risk.
- A score of 3 signifies an 8.5% risk.
- A score of 4 suggests a 15.1% risk.
- A score of 5 indicates a 24.5% risk.

This scoring system helps healthcare providers determine the severity of a patient’s condition and the associated risk of mortality, facilitating informed clinical decisions. The evaluation is carried out by assessing whether each of the five factors is present or absent, computing a total score based on these assessments, and interpreting this score using predefined mortality risk percentages.

The AIMS65 score is a clinical calculator used to predict mortality in patients with upper gastrointestinal (GI) bleeding. The acronym AIMS65 stands for Albumin, International normalized ratio (INR), altered Mental status, Systolic blood pressure, and age 65 years or older. Each of these five factors is assigned one point, and the total score ranges from 0 to 5, with higher scores indicating a higher risk of mortality.

This scoring system is applicable to patients presenting with upper GI bleeding, regardless of the cause. It is particularly useful in the emergency department or inpatient setting to stratify patients based on their risk of mortality, which can guide management decisions such as the need for hospital admission, intensive care, or urgent endoscopy.

There are no specific exclusion criteria for the use of the AIMS65 score. However, it may be less accurate in patients with lower GI bleeding or in those with non-bleeding upper GI disorders. It should also be used with caution in patients with chronic liver disease, as the INR may be elevated in these patients independent of their bleeding risk.

AIMS65 score for upper GI bleeding mortality

Peptic ulcer disease

Indications for surgery

Indications for surgery (perforated ulcer)

Biopsy

Indications for nonoperative management

Indications for nonoperative management (bleeding ulcer)

Endoscopic interventions

Endoscopic interventions, bleeding ulcer

Proton pump inhibitors

PPIs

Endoscopic interventions, perforated ulcer

Diagnostic imaging

Diagnostic imaging (perforated ulcer)

Initial resuscitation

Initial resuscitation (bleeding ulcer)

Antimicrobial therapy

Antimicrobial therapy (perforated ulcer)

Patients with gastric outlet obstruction

Risk and severity assessment

Risk and severity assessment, bleeding ulcer

Angioembolization

Angioembolization, bleeding ulcer

Testing for Helicobacter pylori infection

Testing for H. pylori infection

Laboratory testing

Laboratory testing (perforated ulcer)

Surveillance endoscopy

Patients with erosive gastritis

Indications for nonoperative management (perforated ulcer)

Indications for surgery, bleeding ulcer

Choice of surgical approach

Choice of surgical approach (bleeding ulcer)

Choice of surgical intervention

Choice of surgical intervention (bleeding ulcer)

Diagnostic imaging (bleeding ulcer)

Initial resuscitation (perforated ulcer)

Potassium-competitive acid blockers

Antimicrobial therapy (bleeding ulcer)

Patients with nonsteroidal anti-inflammatory drug-associated ulcer

Patients with NSAID-associated ulcer (prevention)

Choice of surgical intervention (perforated ulcer)

Eradication therapy

Patients with NSAID-associated ulcer (management)

Upper gastrointestinal endoscopy

Risk and severity assessment (perforated ulcer)

Choice of surgical approach (perforated ulcer)

Laboratory testing (bleeding ulcer)

Peptic ulcer disease

Guidelines

Key sources