gastroenterology & hepatologyscoring tool
AIMS65 Score
AIMS65 predicts in-hospital mortality in patients with acute upper GI bleeding using five simple criteria: Albumin <30, INR >1.5, altered Mental status, Systolic BP ≤90, and age ≥65.
inputs
✓ when to use
Use alongside Glasgow-Blatchford for upper GI bleed assessment. GBS predicts need for intervention; AIMS65 predicts mortality. Together they provide a comprehensive pre-endoscopy risk profile. AIMS65 ≥2 identifies patients likely to benefit from ICU-level care.
✗ when not to use
AIMS65 predicts mortality, not need for intervention — it should not be used alone for disposition decisions (GBS is better for that). Not validated for lower GI bleeding. Requires albumin and INR, which may not be immediately available at presentation.
clinical pearls
- AIMS65 and GBS serve different purposes: GBS predicts who needs intervention (disposition tool), AIMS65 predicts who will die (prognostic tool). Use both together for comprehensive risk assessment.
- AIMS65 is especially useful for identifying patients who need ICU admission. A score ≥2 should prompt consideration of high-dependency or ICU-level monitoring.
- The 'A' in AIMS65 stands for Albumin — which is often a marker of chronic liver disease, malnutrition, or critical illness rather than just the acute bleed. It captures underlying frailty.
- Unlike GBS, AIMS65 does not have a clear 'safe for outpatient' threshold. A score of 0 has very low mortality but does not exclude the need for endoscopy or transfusion.
- The simplicity of AIMS65 (5 binary items) makes it easy to calculate at the bedside, but it lacks the granularity of GBS for intervention prediction.