Gastroenterology
AIMS65 Score
Mortality risk in upper GI bleeding.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
AIMS65 is a simple risk score that predicts in-hospital mortality in acute upper gastrointestinal bleeding using data available at presentation. One point is given for each of: Albumin <30 g/L, INR >1.5, altered Mental status, Systolic blood pressure ≤90 mmHg, and age >65 — giving a maximum of 5. It was designed to be quick to calculate without requiring endoscopic findings, distinguishing it from scores such as the full Rockall. The acronym captures its five components.
Interpreting the result
Mortality rises with the score. A score of 0–1 indicates lower mortality risk; 2 is intermediate; and 3–5 indicates high mortality risk, with rates climbing into the double digits at the top of the range. AIMS65 also correlates with length of stay and cost. It is best used to flag patients who need closer monitoring and earlier escalation, alongside clinical assessment.
Worked example
A 72-year-old presents with haematemesis, systolic blood pressure of 88 mmHg, albumin of 27 g/L and a normal INR and mental status: Age >65 (1) + Systolic BP ≤90 (1) + Albumin <30 (1) = 3. This is a high-risk score, warranting close monitoring and consideration of high-dependency care.
Pearls / pitfalls
- AIMS65 predicts mortality, whereas the Glasgow-Blatchford score is better at identifying very low-risk patients who may avoid admission or urgent endoscopy.
- It does not include haemoglobin or pulse, so a haemodynamically compromised patient with brisk bleeding can still score low early on.
- Altered mental status should reflect the acute illness; pre-existing cognitive impairment can confound the score.
- A low score does not exclude significant bleeding — ongoing or recurrent haemorrhage requires reassessment regardless of the initial value.
Evidence & validation
Derived and validated by Saltzman and colleagues using a large administrative dataset, AIMS65 has been reproduced in multiple cohorts and is referenced in upper GI bleeding guidance as a pre-endoscopy risk tool, often compared with the Glasgow-Blatchford and Rockall scores.
Frequently asked questions
What does AIMS65 stand for?
Albumin <30 g/L, INR >1.5, altered Mental status, Systolic BP ≤90 mmHg, and age >65. Each scores one point, for a maximum of five.
How does AIMS65 compare with the Glasgow-Blatchford score?
AIMS65 predicts in-hospital mortality, while the Glasgow-Blatchford score is more sensitive for identifying low-risk patients suitable for outpatient management. They answer different questions and are often used together.
What AIMS65 score is high risk?
A score of 3 or more is associated with high in-hospital mortality and should prompt closer monitoring and consideration of higher levels of care.
Can AIMS65 be calculated before endoscopy?
Yes — that is its advantage. All five variables are available at presentation, so it can guide early risk stratification before endoscopic findings are known.
Does a low AIMS65 mean the patient is safe to discharge?
Not on its own. A low mortality score does not exclude significant or ongoing bleeding; discharge decisions need a fuller assessment, often including the Glasgow-Blatchford score.
References
- Saltzman JR, Tabak YP, Hyett BH, 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.
- Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal haemorrhage. ESGE Guideline. Endoscopy. 2021.
Related calculators
Need a calculator we don't have — or a custom tool?
We build evidence-led clinical calculators, dashboards and reference tools for teams.