Select the presence of risk factors to visualize the Strate severity index.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Prognostic stratification of patients hospitalized with acute Lower Gastrointestinal Bleeding (LGIB)
To identify patients at high risk for a "Severe" in-hospital bleeding event (defined as transfusion, surgery, or hemodynamic instability)
Supplementing clinical judgment during the first 24 hours of triage
High-Risk Definition
A "Severe" event in the Strate model includes the need for ≥ 2 units of packed red blood cells, a decrease in Hct ≥ 20%, or early recurrence of bleeding.
Section 2
Formula & Logic
The 7 Clinical Risk Factors (1 pt each)
Heart Rate ≥ 100 bpm (Tachycardia).
Systolic BP ≤ 115 mmHg.
Visible Blood on DRE (Bright red blood or Clots).
History of Prior LGIB.
Current Aspirin Use.
More than 2 Significant Comorbidities (e.g., Renal, Liver, Cardiac).
Abdominal Tenderness on palpation.
Risk Grouping
0 Points
Low Risk (~9% severe bleeding)
1–3 Points
Moderate Risk (~43% severe bleeding)
≥ 4 Points
High Risk (~84% severe bleeding)
Section 3
Pearls/Pitfalls
Strate vs. Oakland
While the Oakland score is optimized to identify patients for *discharge*, the Strate score is optimized to identify the *severe in-hospital bleeder*. A Strate score $ge 4$ is a powerful signal that the patient will likely need urgent IR embolization or surgical intervention.
The Aspirin Weight
Like many LGIB scores, Aspirin is included as a primary risk factor. In diverticular bleeding (the most common LGIB source), Aspirin significantly increases the vulnerability of the vasa recta to erosion and prolongs the bleeding duration.
Clinical Pearls
Presence of clots on DRE suggests a "brisk" bleeding source proximal to the anal verge
BP $le 115$ is a remarkably sensitive threshold for early occult hypovolemia in the elderly
The predictive value for "intervention" is nearly 10x higher in the High-Risk group compared to the Low-Risk group
Section 4
Next Steps
Management Pathways
01
High-Risk (≥ 4): ICU/Step-down admission; Urgent CTA or Colonoscopy within 24 hours; Early surgical consult.
02
Moderate-Risk: Ward monitoring; Elective prep and colonoscopy.
03
Low-Risk: Evaluate for outpatient management using Oakland criteria.
Complementary Scoring
Oakland Score (Safe Discharge)
NOBLADS Score (Asian Validation)
ASGE LGIB Triage Guidelines
Section 5
Evidence Appraisal
The Foundational System
Early predictors of severity in acute lower gastrointestinal tract bleeding.
Strate LL et al. • Archives of Internal Medicine. 2003;163(7):838-43. The primary derivation of the 7-item score.
Developed by Dr. Lisa Strate, a leading LGIB expert at the University of Washington. She recognized that clinicians often struggled to prioritize which "minor" bleeds needed aggressive intervention, leading to her systematic analysis of hemorrhage predictors.
