Glasgow-Blatchford Score (Glass Cow Black Ford): Upper GI Bleed indications for hospital admission

To determine if the patient requires admission or can be discharged, the Glasgow-Blatchford Score (GBS) is used.

Here’s the ABCDEF mnemonic and why these factors increase the risk of an upper GI bleed:

• ​ A - Active: Conditions like syncope or melena indicate ongoing or significant bleeding, increasing risk severity.

• ​ B - Blood Urea Nitrogen: Levels ≥ 7 mg/dL suggest impaired kidney function, which is often associated with poor systemic clearance and bleeding risk.

• ​ C - Circulation: A systolic blood pressure ≥ 110 mm Hg may reflect hemodynamic instability or stress response to bleeding.

• ​ D - Drop in Hemoglobin: Hemoglobin levels ≤ 12.9 g/dL (men) or ≤ 11.9 g/dL (women) indicate anemia, suggesting significant blood loss.

• ​ E - Elevated Pulse: A pulse rate ≥ 100/min signals compensatory tachycardia, often a response to blood loss.

• ​ F - Failure: Cardiovascular or liver disease impairs clotting and hemodynamic stability, exacerbating bleed risk.

Developed in Scotland, the GBS is a risk assessment tool for upper GI bleeds and considers symptoms, vital signs, and lab values on admission. Key factors in the score include melena, syncope, liver disease, heart failure, heart rate, blood pressure, hemoglobin, and BUN levels. Points are assigned based on these variables to assess the severity of bleeding and volume loss.

For example:

• ​Melena suggests significant GI bleeding, whereas isolated hematemesis (like coffee-ground emesis) has no scoring points.
• ​Syncope, tachycardia, hypotension, and changes in Hb/BUN levels suggest volume loss.
• ​Comorbid conditions (e.g., liver disease) may indicate a need for admission, especially if variceal bleeding is suspected.

Discharge criteria also include access to follow-up care, a support system, and a nearby hospital for emergency returns if symptoms worsen.

For more on current recommendations, consult the 2021 American Journal of Gastroenterology guidelines on upper GI bleeding.