Medical AIGlasgow-Blatchford Bleeding Score (GBS) for upper GI bleeding
A pre-endoscopy score (0 to 23) using blood urea, haemoglobin, systolic blood pressure, pulse, and clinical features to predict the need for intervention (transfusion, endoscopic therapy, or surgery) in acute upper gastrointestinal bleeding. A score of 0 (some use up to 1) identifies very-low-risk patients who may be considered for outpatient management.
How to measure each input
- Blood urea (mmol/L)
- Enter serum urea in mmol/L. This is not the same number as BUN in mg/dL: multiply BUN (mg/dL) by 0.357 to get urea in mmol/L. A raised urea out of proportion to creatinine supports an upper GI source from absorbed blood.
- Haemoglobin (g/dL)
- Use the presenting haemoglobin. Bands are sex-specific: men score from below 13.0 g/dL, women from below 12.0 g/dL. If the laboratory reports g/L, divide by 10.
- Systolic blood pressure
- Initial systolic blood pressure at presentation. Lower pressures score more points (100 to 109 = 1, 90 to 99 = 2, below 90 = 3).
- Clinical features
- Pulse of 100 per minute or more, melena, hepatic disease, and cardiac failure each add 1 point; presentation with syncope adds 2.
Interpretation
| Band | Meaning |
|---|---|
| 0, very low risk | A score of 0 identifies patients at very low risk of needing transfusion, endoscopic therapy, or surgery, who may be considered for outpatient management with early outpatient endoscopy rather than admission. Apply only after clinical judgement and local protocol agree. |
| 1 to 5, low to intermediate risk | Rising probability of needing intervention. Some services extend the outpatient threshold to a score of 1 or less, but most patients in this band warrant inpatient assessment and timely endoscopy. |
| 6 or more, high risk | In the original validation, scores of 6 or more carried greater than a 50% risk of needing intervention. Admit, resuscitate, and arrange urgent endoscopy per guideline timelines. |
Pitfalls, exclusions and caveats
- Urea is entered in mmol/L, not BUN in mg/dL. Entering BUN directly understates the score and the risk.
- The score predicts need for intervention, not mortality, and does not incorporate age or comorbidity directly beyond hepatic and cardiac disease.
- The very-low-risk (score 0) outpatient pathway depends on reliable follow-up, no relevant comorbidity, and local protocol agreement; it is a supported option, not an automatic discharge.
- Haemoglobin and blood pressure can be falsely reassuring early in a brisk bleed before equilibration; reassess after resuscitation.
- It was derived to triage suspected upper GI bleeding and should not be applied to lower GI bleeding or to follow response to therapy.
Sum of banded and single-item points. Blood urea (mmol/L): 6.5 to 7.9 = 2, 8.0 to 9.9 = 3, 10.0 to 24.9 = 4, >= 25 = 6. Haemoglobin (men, g/dL): 12.0 to 12.9 = 1, 10.0 to 11.9 = 3, < 10.0 = 6. Haemoglobin (women, g/dL): 10.0 to 11.9 = 1, < 10.0 = 6. Systolic BP (mmHg): 100 to 109 = 1, 90 to 99 = 2, < 90 = 3. Plus 1 point each: pulse >= 100/min, melena, hepatic disease, cardiac failure; and 2 points for syncope. Total 0 to 23.The Glasgow-Blatchford Bleeding Score was described by Blatchford, Murray, and Blatchford (2000). This implementation is an educational tool and is not affiliated with the original authors or any guideline body.
Frequently asked
What Glasgow-Blatchford score is low enough for outpatient management?
A score of 0 identifies patients at very low risk of needing transfusion, endoscopy, or surgery, who may be considered for outpatient management with early outpatient endoscopy. Some services extend this to a score of 1 or less. The decision still depends on clinical judgement, comorbidity, and reliable follow-up.
Do I enter urea or BUN?
Enter serum urea in mmol/L, which is what the original score uses. If your laboratory reports blood urea nitrogen (BUN) in mg/dL, multiply by 0.357 to convert to urea in mmol/L before entering it.
How does the Glasgow-Blatchford score differ from the Rockall score?
The Glasgow-Blatchford score uses only admission data (no endoscopic findings) and predicts the need for intervention, making it useful for the initial triage and outpatient decision. The full Rockall score incorporates endoscopic findings and predicts rebleeding and mortality after endoscopy.
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