Pre-endoscopy triage in upper-GI bleeding (Blatchford 2000).

What it is and when to use it

The Glasgow-Blatchford Score (GBS) risk-stratifies patients presenting with upper gastrointestinal bleeding and identifies those at low risk of needing clinical intervention (blood transfusion, therapeutic endoscopy, or surgery) or of dying. It is calculated from data available at admission, without endoscopy: urea, haemoglobin, systolic blood pressure, heart rate, melaena, syncope, hepatic disease, and cardiac failure. It is useful in the emergency department to decide on early discharge versus admission. The ESGE and NICE guidelines recommend using the GBS for initial pre-endoscopic assessment.

How to interpret it

The score ranges from 0 to 23: the higher the value, the greater the risk of intervention or death. A score of 0 (or ≤1 in some protocols) identifies very-low-risk patients who may be considered for outpatient management with deferred endoscopy, as the probability of needing transfusion, haemostasis, or surgery is very low. Higher scores are progressively associated with greater need for intervention and support admission and early endoscopy. There is no single universal high-risk threshold; the GBS's main practical value is its high sensitivity for ruling out low-risk patients.

Limitations and when not to use it

Validated in adults with acute upper gastrointestinal bleeding. The GBS is a prognostic tool to guide disposition; it does not diagnose the source of bleeding nor replace endoscopy. It should not be used for lower gastrointestinal bleeding. Urea can be elevated for reasons unrelated to bleeding (renal failure, dehydration) and the initial haemoglobin may not yet reflect acute loss, which can over- or under-estimate risk. Clinical judgement must be maintained: a low GBS does not exclude serious pathology when the presentation is concerning.

Frequently asked questions

What is the difference between the Glasgow-Blatchford and Rockall scores?

The Glasgow-Blatchford is applied before endoscopy and predicts the need for intervention, whereas the full Rockall score incorporates endoscopic findings and is more oriented to predicting mortality and rebleeding.

What Glasgow-Blatchford score allows discharge from the emergency department?

A GBS of 0 (and ≤1 in some protocols) identifies very-low-risk patients suitable for outpatient management with deferred endoscopy, always alongside individual clinical assessment.

What parameters do I need to calculate the Glasgow-Blatchford score?

Urea, haemoglobin, systolic blood pressure, and heart rate, plus the presence of melaena, syncope, hepatic disease, and cardiac failure; no endoscopy is required.