Glasgow-Blatchford Score (GBS)

GBS explained

This is a hemorrhage risk stratifying tool for patients with UGIB and is based on a series of clinical and laboratory determinations:

According to the above, the low risk scenario presentation has:

■ Blood urea nitrogen level <6.5 mmol/L;

■ Hemoglobin level >13 g/dL (male) or >12 g/dL (female);

■ Systolic blood pressure >109 mmHg;

■ Pulse <100 beats per minute;

■ No melena or syncope;

■ No past or present liver disease or cardiac failure.

The main limitation of the model is the fact that it can only be used for patients diagnosed with upper GI bleeding and not lower one, where the haemorrhage source may be unclear.

A similar model, the Rockall score is addressed to pre-endoscopic patients with UGIB. This score has been criticised for allowing clinicians too much space in the evaluation of the patient’s condition.

Result interpretation

The risk factors in the score are weighted differently depending on their implication in further bleeding risk and need for surgery. The total score varies from 0 to 23, where the higher the score, the higher the risk.

Scores of 0 are considered low risk and the patient is likely to be discharged and continue with outpatient therapy.

Scores between 1 and 5 indicate a higher risk, however, the chance for the patient to require surgery is not that significant.

Scores of 6 or more have an increased risk of acute upper gastrointestinal bleeding (UGIB) and chances of over 50% to need surgical intervention, blood transfusion or endoscopic intervention.

In the case of some low risk patients (those suffering from hematemesis), endoscopy may be required at some point but this is rather elective than compulsory.

About the study

The model has been created following a study in 2000, by Blatchford et al., on a cohort of 1748 patients admitted for upper-gastrointestinal haemorrhage.

The numerical score has been derived by logistic regression. The score discriminated well with a ROC curve area of 0.92 (95% CI 0.88-0.95).

What resulted was a nine factor model that predicts patients' risk of needing blood transfusion or intervention to control bleeding, risk of rebleeding, or mortality risk.

Associated with the score, there is also a simplified fast-track screen for use at initial presentation.

Management of UGIB

Upper gastrointestinal bleeding is a medical emergency condition, most commonly caused by peptic ulcer followed by erosive esophagitis but also by other digestive conditions.

UGIB is diagnosed via endoscopy and the earlier, the better management can be provided. Further risk assessment is required to check whether the patient needs or might need endoscopic treatment.

Clips, thermocoagulation or epinephrine injections can first hand stop the bleeding and decrease associated risks (need for transfusion, surgery)

High risk patients may require profound acid suppressive therapy with intravenous PPI.

Original source

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

Validation

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; 2 5(7):774-9.

Other references

1. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997; 315(7107):510-4.

2. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011; 74(6):1215-24.

3. Stanley AJ, Ashley D, Dalton HR, Mowat C, Gaya DR, Thompson E, Warshow U, Groome M, Cahill A, Benson G, Blatchford O, Murray W. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009; 373(9657):42-7.

4. Stanley AJ et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017; 356: i6432.