Glasgow-Blatchford bleeding score (GBS)

Screening tool for acute upper gastrointestinal bleeding (UGIB)

Blood Urea:
Hemoglobin in g/dL:
(Must select based on the gender of the patient- examine carefully)
 
Systolic BP in mm Hg:
Pulse:
Did the patient present with melena? 
Did the patient present with syncope? 
Hepatic disease:
Heart failure:

Background Info

Acute bleeding from the upper gastrointestinal track (UGIB) is a relatively common emergency.The Glasgow-Blatchford bleeding score (GBS) is a useful screening tool that helps determine if a patient who presents with this condition requires medical treatment or intervention including blood transfusion or endoscopic evaluation.  This simple scoring system helps identify patients at highest risk requiring aggressive treatment to control gastrointestinal bleeding.

Key points:

  • Score derived from clinical information available during initial assessment.
  • Advantages of the Glasgow-Blatchford bleeding score over the Rockall score-assesses the risk of mortality in patients with UGIB - include:
    • Lack of subjective variables
    • Lack of need for endoscopy (OGD) to complete the score.
  • The tool may be able to identify patients that can be treated in an outpatient setting after an UGIB.
  • The scoring system was found to be strongly predictive of the need for clinical intervention to control bleeding. It also performed better than the Rockall score  in predicting patients at high risk.
  • Potential pitfall:  The lack of endoscopic analysis may increase the number of patients treated in a hospital setting that could have been treated in an outpatient setting if early endoscopy was used to further assess the patient.
  • The Rockall score can better predict overall mortality.
Glasgow-Blatchford Score
Admission risk marker Score component value
Blood Urea (mmol/L)
<6.5 0
6.5-8.0 2
8.0-10.0 3
10.0-25 4
>25 6
Hemoglobin (g/dL) for men
>12.9 0
12.0-12.9 1
10.0-11.9 3
<10.0 6
Hemoglobin (g/dL) for women
>11.9 0
10.0-11.9 1
<10.0 6
Systolic blood pressure (mm Hg)
>109 0
100–109 1
90–99 2
<90 3
Other markers
Pulse >/=100 (per min) 1   (<100 = 0)
Presentation with melena 1   (no = 0)
Presentation with syncope 2   (no = 0)
Hepatic disease 2    (no = 0)
Cardiac failure 2    (no = 0)

 

If all of the current parameters are within the limits listed below, the total score would be zero. The risk of an acute  upper gastrointestinal bleed would be less than 1.8% (low risk).  In a controlled study, 16% of patients presented with a score of zero and there were no deaths or interventions needed. Also, these patients were effectively treated in an outpatient setting.

  • Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
  • Systolic blood pressure >109 mm Hg
  • Pulse <100/minute
  • Blood urea nitrogen level <6.5 mg/dL
  • No melena
  • No syncope
  • No past or present liver disease or heart failure

References
  1. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000;356:1319.

  2. Gralnek IM, Dulai GS. Incremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage. Gastrointestinal endoscopy. 2004 Jul; 60(1):9-14.
  3. Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. Journal of gastroenterology and hepatology. 2007 Sep; 22(9):1404-8.