Glasgow-Blatchford Bleeding Score (GBS)

• Use for adult patients being considered for hospital admission due to upper GI bleeding.
• Do NOT use in pediatric patients or patients with suspected small bowel or lower GI bleeding.
• Its use is controversial for patients already admitted, as very few were represented in the original cohort and many of these patients receive endoscopic evaluation.

• The Glasgow-Blatchford Bleeding Score (GBS) helps identify which patients with upper GI bleeding (UGIB) may be safely discharged from the emergency room.
• Any of the 9 variables, if present, increase the priority for admission (and likelihood of need for acute intervention).
• Scores range from 0-23, with higher scores corresponding to increasing acuity and mortality.
• A score of 0 suggests low risk of complications (0.5%) and these patients may likely not need to be admitted for workup.
• Scores >0 do not imply that the patient must be admitted.
• Clinicians must use their best judgment in assessing whether the patient has heart failure or liver disease. For example, a mild elevation in liver enzymes or steatosis is not considered hepatic failure; likewise, mild diastolic dysfunction was not considered heart failure in the model.
• History of coffee-ground emesis is NOT counted in the tool as it has a low risk of case fatality (likelihood ratio 0.5).

Points to keep in mind:

• Clinicians must use their best judgment in assessing whether the patient has heart failure or liver disease. For example, a mild elevation in liver enzymes or steatosis is not considered hepatic failure; likewise, mild diastolic dysfunction was not considered heart failure in the model. History of coffee-ground emesis is NOT counted in the tool as it has a low risk of case fatality (likelihood ratio 0.5).
• Its use is controversial for patients already admitted, as very few were represented in the original cohort and many of these patients receive endoscopic evaluation.
• Variables such as age, creatinine, coagulopathy, mental status, and comorbidities like malignancy or pulmonary disease are not a part of this calculator, although they may impact medical decision making. Other risk assessment tools like the Rockall and AIMS65 Scores account for these variables.

• Easy and quick to calculate.
• Doesn’t rely on endoscopic findings.
• Aids in efficient resource utilization.
• Spares the use of NG lavage.
• Scores correlate with cost and length of stay, need for blood transfusion, endoscopic treatment, surgery, and mortality.
• Well-validated in numerous populations.
• Variables such as age, creatinine, coagulopathy, mental status, and comorbidities like malignancy or pulmonary disease are not a part of this calculator, although they may impact medical decision making. Other risk assessment tools like the Rockall and AIMS65 scores account for these variables.
• Has been found to be superior to the AIMS65 in predicting need for intervention (transfusion, endoscopic treatment, IR, or surgery) or rebleeding, although the AIMS65 remains a better predictor of mortality (Stanley 2017).