Lit of the Week — 5/3/16


Lit of the Week – 5/3/16

Glasgow Blatchford Bleeding Score


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. PubMed PMID: 11073021



Clinical question / background:

  • Can a risk score based on medical history, hemodynamic variables, and simple lab data risk stratify patients presenting with upper GI bleed to the emergency department?



  • Retrospective development of scoring system using logistic regression of objective data from large patient database followed by prospective validation using ROC curves compared to Rockall scoring and post-endoscopy scores
  • 1748 patients with UGIB in retrospective group
    • 19 hospitals in Scotland
  • 197 patients with UGIB in validation group
    • 2 hospitals in Scotland
  • Primary outcome: clinical intervention
    • Blood transfusion
    • Any operative or endoscopic procedure to control bleeding
    • Death, re-bleed, or substantial fall in hemoglobin after admission



  • Evaluation of Scoring system as detailed below
Glasgow-Blatchford Score
Admission risk marker Score component value
Blood Urea (mmol/L)
6.5-8.0 2
8.0-10.0 3
10.0-25 4
>25 6
Hemoglobin (g/L) for men
12.0-12.9 1
10.0-11.9 3
<10.0 6
Hemoglobin (g/L) for women
10.0-11.9 1
<10.0 6
Systolic blood pressure (mm Hg)
100–109 1
90–99 2
<90 3
Other markers
Pulse ≥100 (per min) 1
Presentation with melena 1
Presentation with syncope 2
Hepatic disease 2
Cardiac failure 2


Score is equal to “0” if the following are all present:



  • area under the ROC curve of GB score was 0·92 (95% CI 0·88–0·95), which was significantly higher than that for Rockall admission (0·71 [0·64–0·78]) and the full postendoscopy scores (0·75 [0·67–0·83]
  • GB score more highly correlated with need for blood transfusion and hospital length of stay



  • In patients presenting with signs/sxs of acute UGIB, the GB score can be used to risk stratify them for need for further intervention



  • Easy to use based on common admission lab data
  • META-analysis found that score of 0 was associated with a low likelihood of the need for urgent endoscopic intervention (likelihood ratio 0.02, 95% confidence interval [CI] 0-0.05)



  • Only applicable for acute UGIB
  • Score of 1 or greater indicates probable need for intervention limiting its use if patients with chronic anemia, renal disease


Real World

  • Score 0
    • Low risk for intervention
    • Reasonable to manage as outpatient
  • Score >0
    • Increased risk for intervention and inpatient management is recommended
    • However most cases <5 respond without significant intervention
  • Score >5
    • High risk for intervention


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