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    Glasgow-Blatchford Bleeding Score (GBS)

    Stratifies upper GI bleeding patients who are “low-risk” and candidates for outpatient management.
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    When to Use
    Pearls/Pitfalls
    Why Use
    • 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).
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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Once the decision for admission has been made, efforts should focus on stratifying patients into high and low risk categories to determine which patients need ICU admission and urgent endoscopy.

    Management

    Initial management should always focus on hemodynamic resuscitation prior to risk stratification.

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    About the Creator
    Dr. Oliver Blatchford
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