Glasgow-Blatchford
Encyclopedia
The Glasgow-Blatchford bleeding score (GBS) is a screening tool
to assess the likelihood that a patient with an acute upper gastrointestinal bleeding
(UGIB) will need to have medical intervention such as a blood transfusion
or endoscopic intervention. A recent study published in the Lancet
showed that the tool may be able to identify patients who do not need to be admitted to hospital after a UGIB. Advantages of the GBS over the Rockall score
, which assesses the risk of mortality in patients with UGIB, include a lack of subjective
variables such as the severity of systemic diseases and the lack of a need for esophagogastroduodenoscopy
(EGD) to complete the score, a feature unique to the GBS.
In a study published in Lancet
on January 3, 2009, 16% of patients presenting with UGIB had a GBS score of "0", considered low. Among these patients there were no deaths or interventions needed and the patients were able to be effectively treated in an outpatient setting.
In the validation group, scores of 6 or more were associated with a greater than 50% risk of needing an intervention.
Screening (medicine)
Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease....
to assess the likelihood that a patient with an acute upper gastrointestinal bleeding
Upper gastrointestinal bleeding
Upper gastrointestinal bleeding refers to hemorrhage in the upper gastrointestinal tract. The anatomic cut-off for upper GI bleeding is the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon.Upper GI bleeds are considered...
(UGIB) will need to have medical intervention such as a blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
or endoscopic intervention. A recent study published in the Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
showed that the tool may be able to identify patients who do not need to be admitted to hospital after a UGIB. Advantages of the GBS over the Rockall score
Rockall score
Rockall risk scoring system attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding. Rockall et al. identified independent risk factors which were later shown to predict mortality accurately...
, which assesses the risk of mortality in patients with UGIB, include a lack of subjective
Subjectivity
Subjectivity refers to the subject and his or her perspective, feelings, beliefs, and desires. In philosophy, the term is usually contrasted with objectivity.-Qualia:...
variables such as the severity of systemic diseases and the lack of a need for esophagogastroduodenoscopy
Esophagogastroduodenoscopy
For other expansions of the initialism "OGD", see the disambiguation page.In medicine , esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum...
(EGD) to complete the score, a feature unique to the GBS.
In a study published in Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
on January 3, 2009, 16% of patients presenting with UGIB had a GBS score of "0", considered low. Among these patients there were no deaths or interventions needed and the patients were able to be effectively treated in an outpatient setting.
Criteria
The score is calculated using the table below:| Admission risk marker | Score component value |
|---|---|
| Blood Urea | |
| ≥6·5 <8·0 | 2 |
| ≥8·0 <10·0 | 3 |
| ≥10·0 <25·0 | 4 |
| ≥25 | 6 |
| Haemoglobin (g/L) for men | |
| ≥12.0 <13.0 | 1 |
| ≥10.0 <12.0 | 3 |
| <10.0 | 6 |
| Haemoglobin (g/L) for women | |
| ≥10.0 <12.0 | 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 melaena | 1 |
| Presentation with syncope | 2 |
| Hepatic disease | 2 |
| Cardiac failure | 2 |
In the validation group, scores of 6 or more were associated with a greater than 50% risk of needing an intervention.
Score
Score is equal to "0" if the following are all present:- HemoglobinHemoglobinHemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
level >12.9 g/dL (men) or >11.9 g/dL (women)
- Systolic blood pressure >109 mm Hg
- PulsePulseIn medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
<100/minute
- Blood urea nitrogen level <18.2 mg/dL
- No melenaMelenaIn medicine, melena or melaena refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.-Melena vs...
or syncopeSyncope (medicine)Syncope , the medical term for fainting, is precisely defined as a transient loss of consciousness and postural tone characterized by rapid onset, short duration, and spontaneous recovery due to global cerebral hypoperfusion that most often results from hypotension.Many forms of syncope are...
- No past or present liver diseaseLiver diseaseLiver disease is a broad term describing any single number of diseases affecting the liver.-Diseases:* Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons , autoimmunity or hereditary conditions...
or heart failure