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Critical Care

Glasgow-Blatchford Score

Pre-endoscopy risk stratification for upper GI bleeding.

When to use: Used in the emergency department for patients presenting with upper GI bleeding to decide on need for urgent endoscopy, inpatient admission, or safe outpatient management. Score 0 allows safe discharge without endoscopy.
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Formula
GBS = BUN (0–6) + Haemoglobin (0–6) + SBP (0–3) + HR≥100 (1) + Melena (1) + Syncope (2) + Liver disease (2) + Cardiac failure (2)
Key Points for NEET PG
  • GBS 0 is the only score validated for safe discharge without endoscopy — reduces unnecessary admissions
  • Compared to Rockford score, GBS is superior pre-endoscopy; Rockford is used post-endoscopy
  • BUN elevation in UGIB reflects blood digestion and absorption — "pre-renal" pattern from volume loss
  • Melena (black tarry stool) indicates upper GI source; hematochezia from upper GI = massive bleed
  • Commonest UGIB causes: peptic ulcer (35–50%), gastric erosions, varices, Mallory-Weiss tear
References
A risk score to predict need for treatment for upper-gastrointestinal haemorrhage · The Lancet (2000)
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