The Glasgow-Blatchford bleeding score (GBS) is based on simple clinical and laboratory variables; a score of 0 identifies low-risk patients who might be suitable for outpatient management:
- study evidence shows that GBS identifies many patients presenting to general hospitals with upper-gastrointestinal haemorrhage who can be managed safely as outpatients. This score reduces admissions for this condition, allowing more appropriate use of in-patient resources (1)
- advantages of the GBS over the Rockall score, which assesses the risk of mortality in patients with upper GI bleeding, includes:
- lack of subjective variables such as the severity of systemic disease
- lack of a need for oesophagogastroduodenoscopy (OGD) to complete the score, a feature unique to the GBS
The factors used in the GBS include blood urea, haemoglobin value, systolic blood pressure and pulse rate.
- Blood urea (mmol/L)
- 6·5-7·9 = 2 points
- 8·0-9·9 = 3 points
- 10·0-25·0 = 4 points
- >25·0 = 6 points
- Haemoglobin for men (g/L)
- 120-129 =1 points
- 100-119 = 3 points
- <100 = 6 points
- Haemoglobin for women (g/L)
- 100-119 =1 point
- <100 = 6 point
- Systolic blood pressure (mm Hg)
- 100-109 =1point
- 90-99 =2 point
- <90 =3 point
- Other markers Pulse
- >=100/min =1 point
- presentation with melaena = 1 point
- presentation with syncope = 2 point
- hepatic disease* = 2 point
- cardiac failure** =2 point
- * Known history, or clinical and laboratory evidence, of chronic or acute liver disease.
- **Known history, or clinical and echocardiographic evidence, of cardiac failure
- Low-risk criteria of GBS
- urea <6·5 mmol/L
- haemoglobin >=130 g/L (men) or >=120 g/L (women)
- systolic blood pressure >=110 mm Hg
- pulse <100 beats per min
- absence of melaena, syncope, cardiac failure, or liver disease
In the validation group, scores of 6 or more were associated with a greater than 50% risk of needing an intervention
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