Glasgow-Blatchford score

Q: What Glasgow-Blatchford score allows outpatient management?

ESGE 2021 uses a score of 0 or 1: these patients have a very low risk of rebleeding, death or needing intervention, and ESGE considers outpatient endoscopy usually appropriate for them, provided nothing else requires admission.

Q: Should I use urea or BUN in the Blatchford score?

The score is defined on blood urea in mmol/L. If your laboratory reports BUN in mg/dL, multiply by 0.357 to get urea in mmol/L.

Q: Is the Glasgow-Blatchford score better than the Rockall score?

For deciding who needs a hospital intervention or can go home, yes — in the large international comparison by Stanley et al. (BMJ 2017) the GBS had the highest accuracy. The complete Rockall score is mainly a mortality predictor after endoscopy.

Pre-endoscopy risk in upper GI bleeding — who can be managed as an outpatient

ESGE 2021 NVUGIH guideline

Sources last checked: 2026-10-13

Glasgow-Blatchford score

Pre-endoscopy risk in upper GI bleeding — who can be managed as an outpatient

Blood urea (mmol/L)Urea, not BUN. BUN (mg/dL) × 0.357 = urea (mmol/L); urea (mg/dL) ÷ 6.006 = mmol/L.Haemoglobin (g/L)g/dL × 10 = g/L

Sex

Systolic blood pressure (mmHg)Pulse ≥ 100 /min+1Presentation with melaena+1Presentation with syncope+2Hepatic disease (known history or clinical / laboratory evidence)+2Cardiac failure (known history or clinical / echo evidence)+2

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Validated for upper GI bleeding at presentation. A score ≤ 1 speaks for outpatient care only in the absence of other reasons for admission (e.g. ongoing haematemesis, social factors).

Source: Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356(9238):1318-1321.Open

Interpretation

0–1 — very low risk	ESGE 2021: very low risk of rebleeding, 30-day death or need for hospital-based intervention; the guideline describes this group as suitable for outpatient management with outpatient endoscopy.
≥ 2 — not low risk	Not in the very-low-risk group; ESGE 2021 foresees hospital admission and in-hospital endoscopy for this group. Higher scores mean a higher likelihood of needing transfusion, endoscopic or other intervention.

What is the Glasgow-Blatchford score?

The Glasgow-Blatchford score (GBS) estimates, before endoscopy, how likely a patient with upper gastrointestinal bleeding is to need a hospital intervention such as transfusion, endoscopic therapy or surgery. Oliver Blatchford and colleagues derived it in 2000 from consecutive admissions in the west of Scotland. It uses only urea, haemoglobin, blood pressure, pulse and simple history items.

When to use it

Adult presenting with haematemesis, coffee-ground vomiting or melaena, before endoscopy
Emergency department triage: identifying very-low-risk patients for outpatient endoscopy
Deciding urgency of endoscopy alongside haemodynamic assessment

When not to use it

Lower GI bleeding (haematochezia without an upper source) — use a lower-GI score
Patients already in hospital who start bleeding — the score was derived at presentation
As the only basis for discharge when other admission reasons exist

How it is calculated

Urea: < 6.5 → 0; 6.5–< 8 → 2; 8–< 10 → 3; 10–< 25 → 4; ≥ 25 mmol/L → 6. Haemoglobin men: ≥ 130 → 0; 120–129 → 1; 100–119 → 3; < 100 g/L → 6. Women: ≥ 120 → 0; 100–119 → 1; < 100 g/L → 6. Systolic BP: ≥ 110 → 0; 100–109 → 1; 90–99 → 2; < 90 mmHg → 3. Pulse ≥ 100 → 1; melaena → 1; syncope → 2; hepatic disease → 2; cardiac failure → 2.

Clinical pearls and limitations

Validated for upper GI bleeding at presentation. A score ≤ 1 speaks for outpatient care only in the absence of other reasons for admission (e.g. ongoing haematemesis, social factors).
ESGE 2021 recommends GBS for pre-endoscopy risk stratification; GBS ≤ 1 identifies very-low-risk patients suitable for outpatient management.
Enter urea, not BUN — the cut-offs are in mmol/L of urea; a rising urea reflects digested blood in the upper GI tract.
Haemoglobin may be falsely reassuring early, before haemodilution, and can fall further if bleeding continues.
Higher scores raise the probability of needing intervention but do not grade the timing of endoscopy by themselves.

Frequently asked questions

What Glasgow-Blatchford score allows outpatient management?

ESGE 2021 uses a score of 0 or 1: these patients have a very low risk of rebleeding, death or needing intervention, and ESGE considers outpatient endoscopy usually appropriate for them, provided nothing else requires admission.

Should I use urea or BUN in the Blatchford score?

The score is defined on blood urea in mmol/L. If your laboratory reports BUN in mg/dL, multiply by 0.357 to get urea in mmol/L.

Is the Glasgow-Blatchford score better than the Rockall score?

For deciding who needs a hospital intervention or can go home, yes — in the large international comparison by Stanley et al. (BMJ 2017) the GBS had the highest accuracy. The complete Rockall score is mainly a mortality predictor after endoscopy.

What is the maximum Glasgow-Blatchford score?

23 points.

Evidence and guidelines

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