AIMS65 Score Calculator for Upper GI Bleeding
Calculate the original Saltzman 2011 AIMS65 score from albumin, INR, altered mental status, systolic blood pressure, and age, with exact thresholds and historical mortality context.
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About
This AIMS65 Score calculator reproduces the original Saltzman 2011 five-factor model for patients admitted from emergency departments with acute upper GI bleeding. It uses values available at initial evaluation and does not require endoscopic findings. [1]
The original outcome was in-hospital mortality, with additional associations with length of stay and hospitalization cost. It was not derived as a bleeding-source, rebleeding, endoscopic-intervention, discharge, ICU-admission, or treatment rule. [1]
Formula
Interpretation
| AIMS65 score | Derivation cohort exact-score mortality | Validation cohort exact-score mortality |
|---|---|---|
| 0 | 0.3% | 0.3% |
| 1 | 1.2% | 1.2% |
| 2 | 3.6% | 2.8% |
| 3 | 9.8% | 8.5% |
| 4 | 21.8% | 15.1% |
| 5 | 31.8% | 24.5% |
These are historical cohort observations for patients with exactly each score, not an individual probability or treatment/disposition instruction. [1]
Validation cohort cumulative cutoff groups
| Cumulative group | Mortality in that cutoff group |
|---|---|
| AIMS65 >=1 | 3.2% |
| AIMS65 >=2 | 5.3% |
| AIMS65 >=3 | 10.3% |
| AIMS65 >=4 | 16.5% |
| AIMS65 5 | 24.5% |
These are cumulative cutoff groups, not exact-score rates: 5.3% describes score ≥2, not exact score 2; 10.3% describes score ≥3, not exact score 3; and 16.5% describes score ≥4, not exact score 4. [1]
AIMS65 versus Glasgow-Blatchford
AIMS65 was developed primarily around in-hospital mortality. Glasgow-Blatchford focuses on hospital intervention or treatment-related outcomes and identification of very-low-risk patients. In the 3,012-patient 2017 international study, GBS performed better for intervention/death and endoscopic-treatment prediction, while AIMS65 discriminated mortality better than GBS. These are distinct tasks, and neither score universally replaces the other. [2]
Why AIMS65 0 is not a discharge rule
In that multicenter study, 25% of patients with AIMS65 0 still had the composite of hospital intervention or death. The 2019 International Consensus Group suggested against using AIMS65 to identify very-low-risk patients who might avoid hospitalization or inpatient endoscopy. ACG 2021 and ESGE 2021 instead use GBS 0–1 or ≤1 as their example of the very-low-risk outpatient framework. [2, 3, 4, 5]
Original study scale and limits
The model used 29,222 derivation admissions from 2004–2005 and 32,504 validation admissions from 2006–2007 across 187 U.S. hospitals. AUROC was 0.80 (95% CI 0.78–0.81) in derivation and 0.77 (95% CI 0.75–0.79) in validation. The database did not contain rebleeding, endoscopic, or transfusion-requirement outcomes. [1]
What this score cannot decide
AIMS65 does not diagnose the bleeding source or independently determine discharge, admission, ICU placement, transfusion, medication, reversal, endoscopy timing, embolization, surgery, or other treatment. Hemodynamic instability and active severe bleeding require immediate clinical assessment and must not wait for an online score.
References
- Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215–1224. PMID 21907980. DOI 10.1016/j.gie.2011.06.024.
- Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. PMID 28053181. PMCID PMC5217768. DOI 10.1136/bmj.i6432.
- Barkun AN, Almadi M, Kuipers EJ, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171(11):805–822. PMID 31634917. PMCID PMC7233308. DOI 10.7326/M19-1795.
- Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899–917. PMID 33929377. DOI 10.14309/ajg.0000000000001245.
- Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy Guideline – Update 2021. Endoscopy. 2021;53(3):300–332. PMID 33567467. DOI 10.1055/a-1369-5274.
FAQ
AIMS65 names its five one-point factors: Albumin below 3.0 g/dL, INR above 1.5, source-defined altered Mental status, Systolic blood pressure 90 mmHg or lower, and age older than 65 years. The original score ranges from 0 to 5.
Sources: [1]
The original Saltzman model says age older than 65 years, or >65. Age 65 scores zero; age 66 scores one. This calculator preserves that strict source boundary rather than adopting the ≥65 wording shown by some secondary calculators.
Sources: [1]
Yes. The original criterion is systolic blood pressure 90 mmHg or lower, so 90 is included. A value above 90 does not score this component.
Sources: [1]
No. The original INR criterion is strictly greater than 1.5. INR 1.5 scores zero, while a value above 1.5 scores one.
Sources: [1]
No. The original albumin criterion is below 3.0 g/dL, exactly equivalent to below 30 g/L. Equality scores zero; the calculator compares the submitted decimal before display rounding.
Sources: [1]
The source definition was Glasgow Coma Scale below 14 or a physician designation of disoriented, lethargy, stupor, or coma. Either pathway adds one point; selecting both still adds only one point.
Sources: [1]
Not through the GCS pathway alone. The original threshold is GCS <14, so GCS 14 does not satisfy it and GCS 13 does. A separate physician designation of disoriented, lethargy, stupor, or coma can satisfy the source criterion.
Sources: [1]
Score 2 enters the original Saltzman ≥2 higher mortality-risk grouping. In the original validation cohort, mortality among patients with exactly score 2 was 2.8%; 5.3% instead describes the cumulative group with score ≥2. Neither value is an individual probability or disposition instruction.
Sources: [1]
Five is the maximum because all five one-point criteria are present. The original validation cohort observed 24.5% in-hospital mortality among patients with exactly score 5, but this historical cohort percentage is not a personal prediction or automatic treatment instruction.
Sources: [1]
The original paper reported both exact-score observations and cumulative cutoff groups. Validation mortality was 2.8% among patients with exactly score 2, while 5.3% applied to everyone with score ≥2. This page keeps those two tables separate.
Sources: [1]
Related Calculators
Glasgow-Blatchford Score
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GCS
Record standard Glasgow Coma Scale eye, verbal, and motor responses, calculate a complete score when all are testable, and preserve Not Testable components without a fabricated total.
Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.