Glasgow-Blatchford Bleeding Score (GBS)

Introduction

The GBS helps to identify which patients with upper GI bleeding who may be safely discharged from the emergency room.

• Intended for adults being considered for hospital admission due to upper GI bleeding

• NOT intended for:

  • Pediatric patients or

  • Patients with suspected small bowel or lower GI bleeding

• Controversial in patients already admitted. The original study cohort were mostly outpatient (Emergency Department).

Benefits

• Does not rely on endoscopic findings

• Spares use of NG lavage

• Scores correlated with cost, length of stay, need for blood transfusion, endoscopic treatment, surgery, and mortality
  

Glasgow-Blatchford Score

• Any of the 9 variables, if present, increase the priority for admission

  • BUN, hemoglobin, systolic blood pressure, pulse, melena, syncope, liver disease history,  & cardiac failure

• Scores range from 0-23, with the higher scores corresponding to an increase in acuity and mortality

BUN (mg/dL)

Hemoglobin (g/dL) for men

Hemoglobin (g/dL) for women

Systolic blood pressure (mm Hg)

Other criteria

Low risk = Score of 0

• A GBS of 0 suggests low risk of complications (0.5%) and these patients may not need to be admitted for workup. 

• These patients may not require any "medical intervention," such as transfusion, endoscopy, or surgery. 

• Validation study (Chen et al, 2007) demonstrates high sensitivity (99.6%).

• A Lancet study (Stanley et al, 2009) demonstrated that patients with a score of 0 were discharged and had no GI bleeding mortality at 6 month follow-up.

• GBS is superior to the AIMS65 in predicting the need for intervention or rebleeding, However, the AIMS65 remains a better predictor of mortality (Stanley et al, 2017)

  • Other risk assessment tools (i.e.. Rockall and AIMS65) take into account additional variables not included in the GBS tool, such as age, creatinine, coagulopathy, mental status, and comorbidities (i.e. pulmonary disease or malignancy), which may also impact decision making.

High risk = Score > 0

• Likely to require "medical intervention," such as transfusion, endoscopy, or surgery.

• A higher score correlates with a higher likelihood of needing intervention

  • Scores ≥ 6 are associated with > 50% risk of needing intervention

  • Scores range from 0-23. Higher scores correspond to increasing acuity and mortality

• Upon decision to admit the hospital, stratifying patients into high and low risk categories will assist to determine which patients need ICU admission and urgent endoscopy.

  • Scores > 0 do not imply that the patient must be admitted.

  • Clinician judgement is vital in assessing whether the pateint has heart failure or liver disease.

• GBS is superior to the AIMS65 in predicting the need for intervention or rebleeding, However, the AIMS65 remains a better predictor of mortality (Stanley, 2017)

  • Other risk assessment tools (i.e.. Rockall and AIMS65) take into account additional variables not included in the GBS tool, such as age, creatinine, coagulopathy, mental status, and comorbidities (i.e. pulmonary disease or malignancy), which may also impact decision making.

Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000 Oct 14;356(9238):1318-21.