Management of minor upper gastrointestinal haemorrhage in the community using the Glasgow Blatchford Score

Abstract

Background The Glasgow Blatchford Score (GBS) is a validated risk assessment tool in primary upper gastrointestinal haemorrhage, which accurately predicts the need for intervention (endoscopic therapy, blood transfusion or surgery) or death. Aims To identify the GBS that predicts lack of intervention or death and to apply this to clinical practice by managing low-risk patients in the community. Methods GBSs prospectively calculated on 232 patients with upper gastrointestinal haemorrhage to identify low-risk score. Patients with low-risk of requiring intervention (GBS ≤2, age <70 years) from a further 304 patients were considered for management in the community. Results Fifty-two of 232 patients in the first cohort had a GBS ≤2 and were aged less than 70 years: none of these required intervention or died. In the second cohort 104 of 304 (34.2%) patients had a GBS ≤2 and were aged less than 70 years, none of whom died or required endoscopic therapy, blood transfusion, surgery or died. Thrity-two of 104 (10.5% of total cohort) were safely managed in the community. Conclusion Using the criteria of a GBS ≤2, aged less than 70 years to define patients at ‘low risk’ allows 10.5% of patients with primary upper gastrointestinal haemorrhage to be safely managed in the community.