Glasgow-Blatchford Score Calculator
Glasgow-Blatchford Score Calculator
Score upper gastrointestinal bleeding before endoscopy from eight bedside and laboratory items. A score of 0 or 1 is the very-low-risk group; the haemoglobin bands differ between men and women.
Glasgow-Blatchford score
8 items → 0–23Urea 12.0 mmol/L, haemoglobin 105 g/L in a man, systolic 104 mmHg, pulse 100 or more, melaena, no syncope, no hepatic disease, no cardiac failure
Scoring
Range 0–23 · 0 or 1 is the very-low-risk group
- the haemoglobin item is not symmetrical
- men score 1 at 120–129 g/L, 3 at 100–119 and 6 below 100. Women score 1 at 100–119 and 6 below 100 — no 3-point band. Treating it as one table with a shifted threshold gives a woman at 110 g/L two points she should not have
- urea in mmol/L
- the bands are 6.5, 8.0, 10.0 and 25.0 mmol/L. A BUN in mg/dL is about 2.8 times smaller numerically, so entering one unconverted adds points. Urea rises in gastrointestinal bleeding from absorbed blood protein and from reduced renal perfusion, which is why it earns up to 6 points
- melaena, not haematemesis
- only melaena scores, and it scores 1. Haematemesis appears nowhere — counterintuitive and correct, because the items were selected statistically rather than for face validity
- 0 or 1
- Blatchford’s own very-low-risk group was a score of 0; the ESGE 2021 guideline uses 0 or 1, from Stanley’s 3,012-patient international cohort. Both are quoted because they are different thresholds from different studies
- what it predicts
- the need for hospital-based intervention — transfusion, endoscopic haemostasis, interventional radiology or surgery. Specificity at the low-risk threshold is only 35 to 40%, so most patients above it still need nothing
Worked example
Urea 12.0 mmol/L, haemoglobin 105 g/L in a man, systolic 104 mmHg, pulse 100 or more, melaena, no syncope, no hepatic disease, no cardiac failure
Urea 12.0 falls in the 10.0–24.9 band — 4
Haemoglobin 105 g/L in a man falls in 100–119 — 3. The same value in a woman would score 1
Systolic 104 falls in 100–109 — 1
Pulse ≥ 100 — 1 · melaena — 1 · syncope, hepatic disease, cardiac failure — 0
4 + 3 + 1 + 1 + 1 = 10 points, in the 6-or-more band
Change the sex to female and the total falls to 8 — still the same band, but two points from one item
Every item at its minimum gives 0; every item at its maximum — urea ≥ 25, haemoglobin under 100, systolic under 90, and all five categorical items positive — gives 23, the score's maximum
The Glasgow-Blatchford items
| Item | Threshold | Points |
|---|---|---|
| Blood urea (mmol/L) | 6.5 to 7.9 / 8.0 to 9.9 / 10.0 to 24.9 / 25 or more | 2 / 3 / 4 / 6 |
| Haemoglobin, men (g/L) | 120 to 129 / 100 to 119 / under 100 | 1 / 3 / 6 |
| Haemoglobin, women (g/L) | 100 to 119 / under 100 — no 3-point band | 1 / 6 |
| Systolic blood pressure (mmHg) | 100 to 109 / 90 to 99 / under 90 | 1 / 2 / 3 |
| Pulse | 100/min or more | 1 |
| Melaena | Present at presentation | 1 |
| Syncope | Present at presentation | 2 |
| Hepatic disease | Known history, or clinical and laboratory evidence | 2 |
| Cardiac failure | Known history, or clinical or echocardiographic evidence | 2 |
The three upper-GI bleeding scores answer three questions
| Score | Predicts | Needs endoscopy? | Items |
|---|---|---|---|
| Glasgow-Blatchford | Need for hospital-based intervention | No | 8 |
| Rockall, initial | Mortality | No | 3 |
| Rockall, full | Rebleeding and mortality | Yes | 5 |
| AIMS65 | In-hospital mortality | No | 5 |
A score built to find the patients who need nothing
The Glasgow-Blatchford score was derived from 1,748 consecutive patients presenting with upper gastrointestinal bleeding in Scottish hospitals and validated in a further 197, with a single question in mind: who needs admission and treatment to manage the bleeding, and who does not. Everything about its design follows from that. Every item is available before any endoscope is picked up, the items were chosen statistically rather than for clinical plausibility, and the score is tuned for sensitivity at the low end rather than for discrimination across its range.
It does the job it was built for very well. In the validation group a score of 0 covered 35% of patients with a sensitivity of 98.9% and a negative likelihood ratio of 0.028 for needing intervention; the ESGE 2021 guideline extends the very-low-risk group to 0 or 1 on the strength of Stanley’s international prospective cohort of 3,012 patients, in which a score of 1 or less had a sensitivity of 98.6%. Both thresholds are in current use and they come from different studies, so it is worth knowing which one a local protocol is written against.
The corresponding weakness is specificity, which is around 35 to 40% at that threshold. Most patients who score above the low-risk cut-off will also turn out to need nothing. A score of 10 is not a prediction that this patient will bleed; Blatchford reported that scores of 6 or more carried a greater than 50% risk of needing intervention, which is a long way from certainty. The score was also not derived to predict death, and mortality discrimination is its poorest property — that is what AIMS65 and the Rockall score were built for.
Two items are mis-scored more often than the rest. The haemoglobin bands are genuinely different for men and women rather than shifted: men have a 3-point band at 100 to 119 g/L and women do not, so a woman with a haemoglobin of 110 g/L scores 1 where a man scores 3. And the urea must be a blood urea in mmol/L, not a blood urea nitrogen in mg/dL, which is numerically about 2.8 times smaller. A score is not a diagnosis and a risk derived from a cohort is not a probability for one patient. This states what the number predicted in a named study; the clinician in front of the patient decides what follows.
Frequently asked questions
What Glasgow-Blatchford score is low risk?
Blatchford’s own very-low-risk group was a score of 0, which covered 35% of the validation cohort at a sensitivity of 98.9% for needing intervention. The ESGE 2021 guideline uses 0 or 1, citing Stanley’s international prospective cohort of 3,012 patients where a score of 1 or less had a sensitivity of 98.6% and a specificity of 34.6%. Both figures are in use; check which your local pathway follows.
Why are the haemoglobin bands different for men and women?
The bands were derived empirically, not symmetrically. Men score 1 at 120–129 g/L, 3 at 100–119 and 6 below 100. Women score 1 at 100–119 and 6 below 100 — no 3-point band. A woman at 110 g/L scores 1 and a man scores 3.
Does the Glasgow-Blatchford score use urea or BUN?
Blood urea, in mmol/L, with bands at 6.5, 8.0, 10.0 and 25.0. A BUN in mg/dL is about 2.8 times smaller numerically, so entering one unconverted adds points that are not there — a BUN of 7 mg/dL is a urea of about 2.5 mmol/L, which scores nothing.
Does haematemesis score any points?
No. Only melaena appears in the score, and it scores 1; haematemesis is not an item at all. The items were selected for their statistical contribution rather than for face validity.
Can I use the Glasgow-Blatchford score to predict death?
It is the wrong instrument for that. The score was derived to predict the need for hospital-based intervention, and the systematic review quoted in the ESGE guideline found mortality to be its weakest endpoint. AIMS65 and the initial Rockall score were both derived against mortality.
Related calculators
References
- Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–21.
- Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline — update 2021. Endoscopy. 2021;53(3):300–32.
- Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432 (as reported in the ESGE 2021 guideline).
- Nahon S, Hagège H, Latrive JP, et al. Epidemiological and prognostic factors involved in upper gastrointestinal bleeding. Ann Intensive Care. 2012;2:46 (Table 3, Glasgow–Blatchford score).
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/