Why use it

Simple, fast bedside risk stratification for UGI bleeding before endoscopy. Predicts in-hospital mortality better than the Glasgow-Blatchford score for this endpoint. Guides ICU admission, urgency of endoscopy, and consultation decisions.

About

The AIMS65 score predicts in-hospital mortality in patients with acute upper gastrointestinal (UGI) bleeding using five pre-endoscopy variables: Albumin < 3 g/dL, INR > 1.5, altered Mental status, Systolic BP ≤ 90 mmHg, and age ≥ 65 years. It was developed to stratify patients before endoscopy, enabling rapid disposition decisions and resource allocation.

When to use

Acute upper GI bleeding (hematemesis, melena, or hematochezia with suspected UGI source)
Pre-endoscopy risk stratification
Triage for ICU vs. ward admission
Determining urgency of endoscopic intervention

Formula

1 point each (total 0–5): A = Albumin < 3 g/dL I = INR > 1.5 M = altered Mental status (GCS < 14 or disorientation) S = Systolic BP ≤ 90 mmHg 65 = Age ≥ 65 years

Pearls & pitfalls

AIMS65 predicts in-hospital MORTALITY — Glasgow-Blatchford is better for predicting need for intervention.
Albumin < 3 g/dL is the strongest predictor in the model.
Altered mental status includes confusion, disorientation, lethargy — not intoxication alone.
The Glasgow-Blatchford score is preferred for identifying patients who may be safe for outpatient management.
For complete risk assessment, consider using both AIMS65 (mortality) and GBS (intervention need) together.
All patients with active hematemesis or significant hemodynamic instability require urgent endoscopy regardless of score.

Next steps

Score 0: Very low in-hospital mortality (~0.3%). Score 1: Low (~1%). Score 2: Moderate (~3%). Score 3: High (~9%). Score 4–5: Very high (~15–25%). High scores warrant ICU admission and urgent (within 12–24h) endoscopy.

Evidence

Developed by Saltzman et al. (Ann Intern Med 2011) from 29,222 patients. Validated in the UK (Stanley et al., Gut 2017) and multiple international cohorts. AIMS65 outperforms APACHE II for mortality prediction in acute UGI bleed. AUC ~0.80 for in-hospital mortality.

References

Saltzman JR et al. 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. — link
Stanley AJ et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. — link

AIMS65 Score

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