Published: 2019-12-25

Triaging patients with upper gastrointestinal bleeding: the utility of Glasgow-Blatchford score

Namita Mohanty, Arjun Nataraj Kannan


Background: Glasgow-Blatchford bleeding score (GBS), was developed to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following upper gastrointestinal bleeding. Study evaluated the Glasgow Blatchford score’s (GBS) ability to identify high risk patients who needed blood transfusion in patients with UGI haemorrhage.

Methods: A total of 270 cases admitted with upper gastrointestinal bleeding in the Medical ICU/Wards of MKCG Medical College were put on Blatchford scoring system and classified as those requiring (high risk = GBS >1) and not requiring blood transfusion (low risk) based on the score assigned on admission and a correlation between initial scoring and requirement of blood transfusion was done.

Results: Units of blood transfusion required, the GBS and duration of hospital stay were significantly lower among the low risk group, all with p value <0.001. No blood transfusion was required in patients with GBS <3. There was significant correlation between GB score and requirement of blood transfusion (p <0.001) and duration of hospital stay (p <0.001). GBS had 100% sensitivity, negative predictive value and positive likelihood ratio, when a cut off of > 16 was used in predicting mortality.

Conclusions: Patients presenting with Upper GI bleeding can be triaged in casualty with Glasgow Blatchford scoring. Patients with a low score of less than or equal to 3 can be safely discharged and reviewed on follow up thereby reducing admission, allowing more efficient use of hospital resources.


Blood transfusion, Mortality, Outdoor management

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Network SI. Management of acute upper and lower gastrointestinal bleeding. SIGN Guideline 105. SIGN. 2008:1-40.

Biecker E, Heller J, Schmitz V, Lammert F, Sauerbruch T. Diagnosis and management of upper gastrointestinal bleeding. Dtsch Arztebl Int. 2008 Feb;105(5):85-94.

Jain V, Agarwal P N, Singh R, Mishra A, Chugh A, Meena M. Management of Upper Gastrointestinal Bleed. MAMC J Med Sci. 2015;1:69-79.

Kim J. Management and prevention of upper GI bleeding. Gastroenterology Nutr Series. PSAP-VII; 2012:7-26.

Srirajaskanthan R, Conn R, Bulwer C, Irving P. The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage. Inter J Clini Pract. 2010 Jun;64(7):868-74.

Atkinson RJ, Hurlstone DP. Usefulness of prognostic indices inupper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22:233-42.

Bozkurt S, Köse A, Arslan ED, Erdoğan S, Üçbilek E, Çevik İ, et al. Validity of modified early warning, Glasgow Blatchford, and pre-endoscopic Rockall scores in predicting prognosis of patients presenting to emergency department with upper gastrointestinal bleeding. Scandinavian J Trauma, Resuscitation Emer Med. 2015 Dec;23(1):109.

Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet. 2000 Oct 14;356(9238):1318-21.

Lim JK, Ahmed A. Endoscopic approach to the treatment of gastrointestinal bleeding. Tech Vasc Interv Radiol. 2004 Sep; 7(3):123-9.

Monteiro S, Gonçalves TC, Magalhães J, Cotter J. Upper gastrointestinal bleeding risk scores: Who, when and why?. World J Gastrointestinal Pathophysiol. 2016 Feb 15;7(1):86.

Stanley AJ, Ashley D, Dalton HR, Mowat C, Gaya DR, Thompson E, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009 Jan 3;373(9657):42-7.

Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9.

Pang SH, Ching JY, Lau JY, Sung JJ, Graham DY, Chan FK. Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage. Gastrointes Endo. 2010 Jun 1;71(7):1134-40.

Forrest JH, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974 Aug 17;304(7877):394-7.

Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med. 1994 Sep 15;331(11):717-27.

Peterson WL, Barnett CC, Smith HJ, Allen MH, Corbett DB. Routine early endoscopy in upper-gastrointestinal-tract bleeding: a randomized, controlled trial. N Engl J Med. 1981 Apr 16;304(16):925-9.

Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D. Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers. JAMA. 1990 Jul 25;264(4):494-9.

Longstreth GF, Feitelberg SP. Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage. Lancet. 1995 Jan 14;345(8942):108-11.

Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996 Mar 1;38(3):316-21.

Saeed ZA, Winchester CB, Michaletz PA, Woods KL, Graham DY, A scoring system to predict rebleeding after endoscopic therapy of nonvariceal upper gastrointestinal hemorrhage, with a comparison of heat probe and ethanol injection, Am J Gastroenterol. 1993 Nov;88(11):1842-9.

Hay JA, Lyubashevsky E, Elashoff J, Maldonado L, Weingarten SR, Ellrodt AG, Upper gastrointestinal hemorrhage clinical--guideline determining the optimal hospital length of stay. Am J Med. 1996 Mar;100(3):313-22.

Girardin M, Bertolini D, Ditisheim S, Frossard JL, Giostra E, Goossens N, et al. Use of Glasgow-Blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding. Endo Inter Open. 2014;2(02):E74-9.

Mustafa Z, Cameron A, Clark E, Stanley AJ. Outpatient management of low-riskpatients with upper gastrointestinal bleeding: can we safely extend the Glasgow Blatchford Score in clinical practice? Eur J Gastroenterol Hepatol. 2015 May;27(5):512-5.

Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United Euro Gastroenterol J. 2016 Jun;4(3):371-9.

Nagaraja BS, Vinay K, Akhila Rao K, Umesh KJ, Prashant BC. Comparison of prediction of outcomes in upper GI bleed using nonendoscopic scoring systems Int J Adv Med. 2018 Aug;5(4):838-4.

Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol. 2007 Sep;22(9):1404-8.

Le IJ, Gordon AL, Farrugia D, Manwani R, Guha IN, James MW. Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): can the use of Glasgow-Blatchford Bleeding Score be extended?. Acute Med. 2011;10(4):176-81.

Schiefer M, Aquarius M, Leffers P, Stassen P, van Deursen C, Oostenbrug L, et al. Predictive validity of the Glasgow Blatchford Bleeding Score in an unselected emergency department population in continental Europe. Euro J Gastroenterol Hepatol. 2012 Apr 1;24(4):382-7.

Laursen SB, Dalton HR, Murray IA, et al. Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2015;13(1):115-21.