What the score is for
Upper gastrointestinal bleeding, from the esophagus, stomach or duodenum, shows up as vomiting blood or black, tarry stools (melena). Many patients have only minor bleeding and can safely go home, while others need transfusion, urgent endoscopy or surgery. The Glasgow-Blatchford score (GBS), published by Oliver Blatchford and colleagues in 2000, uses information available at the bedside to tell them apart, before any endoscopy.
The score
| Finding | Points |
|---|---|
| Blood urea (mmol/L): 6.5–7.9 / 8–9.9 / 10–24.9 / 25 or more | 2 / 3 / 4 / 6 |
| Hemoglobin, men (g/dL): 12–12.9 / 10–11.9 / below 10 | 1 / 3 / 6 |
| Hemoglobin, women (g/dL): 10–11.9 / below 10 | 1 / 6 |
| Systolic BP (mmHg): 100–109 / 90–99 / below 90 | 1 / 2 / 3 |
| Pulse of 100/min or more | 1 |
| Melena | 1 |
| Syncope | 2 |
| Liver disease | 2 |
| Heart failure | 2 |
BUN in mg/dL is converted to urea in mmol/L by multiplying by 0.357. The total ranges from 0 to 23.
Worked example
A man with melena has a BUN of 30 mg/dL (urea 10.7 mmol/L), hemoglobin 11.5 g/dL, blood pressure 105 mmHg and a pulse of 96.
- Urea 4 + hemoglobin 3 + blood pressure 1 + melena 1 = 9
A score of 9 indicates a high risk of needing intervention: admission, resuscitation and early endoscopy, usually within 24 hours.
Interpretation
| Score | Meaning |
|---|---|
| 0–1 | Very low risk: outpatient management with early endoscopy is often possible |
| 2–6 | Not low risk: admission and endoscopy |
| 7 or more | High risk of needing transfusion, endoscopic therapy or surgery |
The international consensus and European guidelines recommend that patients with a score of 0 or 1 can be considered for discharge without inpatient endoscopy.
Why it works
A high urea reflects digested blood in the gut; low hemoglobin and blood pressure reflect the volume lost; liver disease and heart failure reduce the margin for error. A score of 0 or 1 has a very high negative predictive value for needing intervention.
Limits
The score does not predict death as well as it predicts the need for intervention. It was not designed for lower GI bleeding. Patients on anticoagulants or with ongoing bleeding need clinical judgment regardless of the score.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.