Oakland et al reported the CANUKA score for evaluating a patient for risk of rebleeding after an episode of upper gastrointestinal bleeding. This can help to identify a patient who can be managed as an outpatient. The authors are from multiple institutions in England, Canada, Australia and the United States.
CANUKA is an acronym for Canada, United Kingdom and Adelaide.
Patient selection: admission for upper gastrointestinal hemorrhage
Parameters:
(1) age in years
(2) melena
(3) hematemesis
(4) syncope
(5) liver disease
(6) malignancy
(7) heart rate in beats per minute
(8) systolic blood pressure in mm Hg
(9) hemoglobin concentration in g/dL
(10) urea in mmol/L
Parameter
Finding
Points
age in years
< 50 years
0
60 to 64.99 years
1
>= 65 years
2
melena
no
0
yes
1
hematemesis
no
0
yes
1
syncope
no
0
yes
1
liver disease
no
0
yes
2
malignancy
no
0
yes
2
heart rate
< 100 beats per minute
0
100 to 124 bpm
1
>= 125 beats per minute
2
systolic blood pressure
>= 120 mm Hg
0
100 to 119 mm Hg
1
80 to 99 mm Hg
2
< 80 mm Hg
3
hemoglobin
>= 12.1 g/dL
0
10.1 to 12 g/dL
1
8.1 to 10 g/dL
2
<= 8.0 g/dL
3
urea
< 5 mmol/L
0
5 to 9.9 mmol/L
1
10 to 14.9 mmol/L
2
>= 15 mmol/L
3
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• A score <= 1 had a positive predictive value for safe discharge of 96%
• A score <= 4 had a positive predictive value for survival of 99%.
Performance:
• The area under the ROC curve is 0.77 for mortality and 0.90 for all measures of poor outcome.
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