Glasgow-Blatchford Score Calculator | Upper GI Bleed Triage

Glasgow-Blatchford Score

Sex

BUN (mg/dL)

Haemoglobin — Men (g/dL)

Systolic BP (mmHg)

Additional risk factors (tick all that apply)

HR ≥ 100 bpm+1 Melena at presentation+1 Syncope+2 Liver disease (known)+2 Cardiac failure (known)+2

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Enter values above

Scoring Components

Component	Threshold	Points
BUN (mg/dL)	< 18.2	0
	18.2 – 22.4	2
	22.4 – 28.0	3
	28.0 – 70.0	4
BUN ≥ 70		6
Hb — Men (g/dL)	≥ 13.0	0
	12.0 – 12.9	1
	10.0 – 11.9	3
Hb Men < 10.0 / Women < 10.0		6
Hb — Women 10.0–11.9		1
SBP (mmHg)	≥ 110	0
	100 – 109	1
	90 – 99	2
SBP < 90		3
HR ≥ 100 bpm		+1
Melena at presentation		+1
Syncope		+2
Liver disease (known)		+2
Cardiac failure (known)		+2

Interpretation

GBS	Risk Level	Clinical Recommendation
0	Very Low	Safe for outpatient management; early discharge without endoscopy may be appropriate (BSG 2019, NICE)
1–2	Low	Inpatient or early outpatient endoscopy; monitor closely
3–5	Moderate	Inpatient endoscopy within 24 hours
≥ 6	High	Urgent endoscopy; likely to require intervention
≥ 12	Very High	Emergency endoscopy; very high probability of needing intervention or transfusion

Clinical Application

The GBS is the recommended pre-endoscopy triage tool for UGIB in BSG (2019), ACG (2021), and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. It outperforms pre-endoscopy Rockall for identifying patients safe for discharge.

Score 0: AUC ~0.93 for identifying patients who can be managed without urgent endoscopy. Approximately 15–20% of UGIB presentations score 0.
Discriminates well for need for transfusion, endoscopic intervention, re-bleeding, and in-hospital mortality.
Important: GBS does not replace clinical assessment — active haematemesis, haemodynamic instability, or clinical concern warrants endoscopy regardless of score.
Post-endoscopy: Once endoscopy is completed, use the full Rockall Score to further risk stratify for re-bleeding and mortality.

Evidence & Validation

The GBS was derived by Blatchford et al. (2000) from 1748 consecutive UGIB admissions in Glasgow. It was specifically designed as a pre-endoscopy triage tool, unlike the Rockall score which requires endoscopy findings.

Multiple validation studies (Cheng et al. 2012, Stanley et al. 2012, Bessa et al. 2011) confirmed its c-statistic of 0.86–0.92 for predicting clinical intervention. The 2015 BSG meta-analysis (Laursen et al.) recommended GBS ≤1 as the threshold for safe early discharge with NPV >99%.

Limitations

Pre-endoscopy only — does not incorporate endoscopic findings
BUN can be elevated in renal failure, high-protein intake, or dehydration unrelated to GI bleeding
Does not account for anticoagulant use, which significantly affects re-bleeding risk
Less useful in patients with chronic renal failure (creatinine-adjusted BUN thresholds may be needed)
Clinical factors like frailty, social circumstances, and patient preference should also guide discharge decisions at score 0–1

References

Blatchford O, et al. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–1321.
Stanley AJ, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage (GBS ≤1). Lancet. 2009;373(9657):42–47.
Laursen SB, et al. The Glasgow-Blatchford Score is the most accurate assessment of patients with upper-GI bleeding. Clin Gastroenterol Hepatol. 2012;10(10):1130–1135.
BSG. Guidelines on the management of acute upper gastrointestinal bleeding. Gut. 2019;68(Suppl 1):1–i57.
Laine L, et al. ACG Clinical Guideline: Upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116(5):899–917.