Glasgow-Blatchford Score (GBS) Calculator

How does this Glasgow-Blatchford score (GBS) calculator work?

This health tool allows the stratification of patients at risk for bleeding in the upper gastro intestinal track and helps the clinician set the inpatient or outpatient management.

The Glasgow-Blatchford score (GBS) calculator works as a screening form checking the likelihood of upper digestive hemorrhage based on the following criteria:

■ Blood Urea (mmol/L) – the lower the BUN determination is, the lower the risk for hemorrhage and intervention in the upper GI.

■ Hemoglobin (g/dL) – discerning whether the patient is male and female with the scoring system varying slightly by gender. The higher Hb value, the less risk for bleeding.

■ Systolic blood pressure (mmHg) – along with heart rate – monitor the overall condition of the cardiovascular system, the higher the values, the greater the risk for the patient.

■ Presentation with syncope – syncope is one of the first signs of hemorrhage, transient loss of conscience, hypotension.

■ History of cardiac disease by echocardiography evidence and any signs of cardiac failure in the past or present.

■ History of hepatic disease with either chronic or acute liver disease or any kind of fibrosis, cirrhosis related or not.

■ Presentation with melena – sign of diffuse bleeding, with or without known cause in the gastrointestinal track.

One of the criticisms of the Blatchford bleeding model is that it can only be used for patient with upper GI bleeding and not for lower GI where the source of hemorrhage might not be clear.

Another useful score used in gastrointestinal bleeding management is the pre endoscopic Rockall score, for mortality risk but in comparison to the Glasgow Blatchford, although both systems can be assessed at first presentation, the Rockall one is a lot more subjective with the clinician being allowed to assess the severity of systemic disease while Blatchford focuses on symptoms.

Blatchford score interpretation

Once the risk stratification system is completed, the clinician will obtain a score ranging from 0 to 23. Scores of 0 are considered low risk while all scores above 0 are deemed high risk for upper gastro intestinal bleeding.

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

Low risk patients even suffering from hematemesis can be monitored outpatient but are still in need for endoscopy, although in their case is rather elective than compulsory.

The low risk scenario presentation should respect the following clinical and laboratory variables:

■ Blood urea nitrogen level <6.5 mmol/L;

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

■ Systolic blood pressure >109 mm Hg;

■ Pulse <100 beats per minute;

■ No melena or syncope;

■ No past or present liver disease or cardiac failure.

Endoscopy is the main diagnosis tool and early risk assessment allows clinicians to provide an efficient management and in stratifying the urgency of endoscopy during or out of the hospital stay.

Acute upper gastrointestinal bleeding (UGIB)

This is one of the conditions that often result in medical emergencies and the most likely cause is peptic ulcer followed by erosive esophagitis and other digestive conditions. Risk assessment is necessary in order to determine whether endoscopic treatment is necessary.

Clips, thermocoagulation, epinephrine injections can first hand stop the bleeding and decrease other risks such as further surgery or need for blood transfusions. High risk patients often require profound acid suppressive therapy with intravenous PPI.

References

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

2) Reed EA, Dalton H, Blatchford O, Ashley D, Mowat C, Gaya DR, Cahill A, Warshow U, Hare N, Groome M, Forrest EH, Morris J, Stanley AJ. (2014) Is the Glasgow Blatchford score useful in the risk assessment of patients presenting with variceal haemorrhage? Eur J Gastroenterol Hepatol; 26(4):432-7.

3) Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. (2007) Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med; 2 5(7):774-9.