GI & Liver

Glasgow-Blatchford Bleeding Score (GBS) Calculator

Risk score for upper GI bleeding that predicts the need for intervention and identifies very-low-risk patients (0–1) for outpatient care.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

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Formula

BUN, mg/dL (urea mmol/L × 2.8): <18.2 = 0; 18.2–22.3 = 2; 22.4–27.9 = 3; 28–70 = 4; >70 = 6
Hemoglobin, men (g/dL): ≥13 = 0; 12–12.9 = 1; 10–11.9 = 3; <10 = 6
Hemoglobin, women (g/dL): ≥12 = 0; 10–11.9 = 1; <10 = 6
Systolic BP (mm Hg): ≥110 = 0; 100–109 = 1; 90–99 = 2; <90 = 3
Pulse ≥100/min = 1; presentation with melena = 1; presentation with syncope = 2; hepatic disease = 2; cardiac failure = 2
Total 0–23 (original units: urea 6.5–7.9, 8.0–9.9, 10.0–25.0, >25 mmol/L; hemoglobin in g/L)

How it is used

• GBS 0–1 is very low risk: ACG 2021 suggests discharge from the ED with outpatient follow-up, and ESGE 2021 says these patients can be managed as outpatients with outpatient endoscopy.
• GBS ≥2: hospital care, resuscitation, then endoscopy within 24 hours (ESGE 2021). A score ≥7 best predicted the need for endoscopic treatment (Stanley 2017).
• In an international study GBS ≤1 was 98.6% sensitive for intervention or death, but the score predicts death less well than the need for intervention (Stanley 2017).
• Derived in patients presenting to hospital with upper GI bleeding (Blatchford 2000); not designed for bleeding that starts in hospital or for lower GI bleeding.

Key points

• An unstable patient needs resuscitation and urgent endoscopy whatever the score.
• An early hemoglobin can look falsely reassuring before fluids equilibrate: recheck it.

Same formula as the app. Open it in the web app.

Related one-pagers

• GI Bleeding, Liver Failure and PancreatitisGlasgow-Blatchford score 0–1: low risk
• Myasthenic Crisis and Guillain-Barré SyndromeGBS with bulbar weakness, dysautonomia or fast progression · Elective intubation; BiPAP tends to fail

Related calculators

• Bedside Index of Severity in Acute Pancreatitis (BISAP)
• Child-Pugh Score (CTP)
• Model for End-Stage Liver Disease (MELD 3.0)

For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.