Dr. Elizabeth Squirell

Glasgow-Blatchford score

Pre-endoscopy risk score for upper GI bleeding, with safe-discharge checks

Reviewed October 2026

For healthcare professionals. A decision aid, not a substitute for clinical judgement.

Score at presentation. Each item adds the points shown on the right.

Blood tests

Use the values at presentation.

SexNeeded for the hemoglobin points.
Hemoglobin
g/L
–
Blood ureaCanadian labs report urea in mmol/L. Switch to BUN (mg/dL) for US results.
mmol/L
–

Vital signs

Systolic blood pressure
mm Hg
–
Heart rate
beats/min
–

Presentation and history

Melena
–
Syncope
–
Hepatic diseaseKnown chronic liver disease, or clinical or laboratory evidence of liver disease.
–
Cardiac failureKnown heart failure, or clinical or echocardiographic evidence of it.
–
Total
–/23

Glasgow-Blatchford score

Answer 9 more items to see the result.

No score is shown until every item is answered. A blank is never counted as normal.

How to use it

Score the patient at presentation, before endoscopy. Enter urea in mmol/L as Canadian labs report it, or switch to BUN (mg/dL) for US results. The BUN bands are the urea bands multiplied by 2.8, so both give the same points.

Nothing is scored until every item is answered. When the score is 0 or 1, three more questions appear. Outpatient care is only offered if all three are No.

Reading the result

GBS Meaning What the guidelines say
0–1 Very low risk of needing transfusion, endoscopic therapy or surgery, or of dying May be managed as an outpatient with outpatient endoscopy (ESGE 2021, strong; ACG 2021; Barkun 2019)
≥2 Not low risk Admit; endoscopy within 24 h of presentation after resuscitation

There is no validated cut-off above 1 that tells you who needs an ICU or urgent endoscopy. Higher scores mean a higher chance of needing an intervention. Use clinical judgement.

The score was built to predict the need for intervention, not death. In the 2017 international study, GBS ≤1 missed about 1 in 70 patients who needed intervention or died (sensitivity 98.6%).

Pitfalls

  • A low score is not the whole decision. Ongoing bleeding, instability, anticoagulants that need reversal, frailty or poor follow-up all mean admission, whatever the score.
  • Urea vs BUN. A urea of 10 mmol/L is a BUN of 28 mg/dL. Entering a BUN into the mmol/L box would overscore the patient.
  • Early hemoglobin can be falsely reassuring because hemodilution takes hours. Recheck it.
  • Other scores. The international consensus advises against AIMS65 for finding low-risk patients, and made no recommendation for or against the pre-endoscopy Rockall score. That is why this tool shows the GBS alone.
  • Transfusion thresholds differ. ACG 2021 suggests 70 g/L for hospitalized patients. The international consensus suggests below 80 g/L without cardiovascular disease and a higher threshold with it. Neither applies to exsanguinating bleeding.

Evidence

The score was derived from 1,748 admissions and discriminated well (ROC area 0.92). Stanley 2009 showed that patients with GBS 0 could go home safely, and Stanley 2017 (3,012 patients, six hospitals on four continents) found that GBS ≤1 is the best threshold for outpatient care. All three current guidelines now use 0–1.

For lower GI bleeding, use the Oakland score.

Try “pregnancy”, “Mayo”, “calprotectin” or “VARSITY”.