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SUMMARY BackgroundThe Glasgow Blatchford Score (GBS) is increasingly being used to predict intervention and outcome following upper gastrointestinal haemorrhage (UGIH).

At presentation, GBS correctly identifies patients with variceal bleeding as high risk and appears superior to the admission Rockall score. However, GBS and both Rockall scores are poor at predicting clinical outcome within this group.

IntroductionThe pre-endoscopic Glasgow Blatchford Score (GBS) can identify low-risk patients with upper gastrointestinal haemorrhage (UGIH) who may be suitable for out-patient management. Although it does not include the patient's age, the GBS appears to have high accuracy in predicting clinically relevant endpoints. Our aim was to compare the GBS with both the pre-endoscopy (admission) and post-endoscopy (full) Rockall scores in predicting need for clinical intervention and mortality.MethodsData on consecutive patients presenting to four UK hospitals (Glasgow Royal Infirmary, Royal Cornwall Hospital Truro, University Hospital of North Tees and Ninewells Hospital Dundee) were collected. Admission history, clinical and laboratory data, endoscopic findings and treatment, and clinical follow-up were recorded. We used ROC curves to compare the three scores in the separate prediction of death, endoscopic or surgical intervention and transfusion.Results1556 patients (mean age 56.7 years; 62% male) presented with UGIH to the four hospitals during the study period. 74 (4.8%) died, 223 (14.3%) had endoscopic or surgical intervention and 363 (23.3%) required transfusion. The GBS was equally effective at predicting death compared with both the admission Rockall score (area under ROC curve 0.804 vs 0.801) and the full Rockall score (AUROC 0.741 vs 0.790). In predicting endo/surgical intervention, the GBS was superior to the admission Rockall score (AUROC 0.858 vs 0.705, p<0.00005) but similar to the full Rockall score (AUROC 0.822 vs 0.797). The GBS was superior to both the admission Rockall (AUROC 0.944 vs 0.756, p<0.00005) and the full Rockall score (AUROC 0.935 vs 0.792, p<0.00005) in predicting need for transfusion.ConclusionDespite not incorporating age, the GBS is as effective as the admission and full Rockall scores in predicting death after UGIH. It is superior to both the admission and full Rockall scores in predicting need for transfusion and superior to the admission Rockall score in predicting endoscopic or surgical intervention.

IntroductionThe Glasgow Blatchford Score (GBS) is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage (UGIH). It can predict need for intervention or death and identifi es low risk patients suitable for out-patient management. 1 There are no published data assessing its use in variceal haemorrhage. Our aim was to compare the GBS with both admission and full Rockall scores in assessment of patients with variceal bleeding. Methods Data on consecutive patients presenting to four UK hospitals (Glasgow Royal Infi rmary, Royal Cornwall Hospital Truro, University Hospital of North Tees and Ninewells Hospital Dundee) were collected. Admission history, clinical and laboratory data, endoscopic fi ndings, intervention and follow-up were recorded. We compared the ability of GBS and both Rockall scores to predict intervention and death in those patients with a fi nal diagnosis of variceal bleeding. Results 1556 patients presented with UGIH to the four hospitals during the study period. 78 had a fi nal diagnosis of variceal bleeding. The mortality of these patients was higher than the non-variceal patients (18% vs 4%; p < 0.0005). On presentation, no variceal bleeding patient had a GBS <3; however, six had an admission Rockall score of zero. The median(range) GBS, admission Rockall and full Rockall scores for the variceal bleeding group were 10(2-18), 3(0-7) and 5(1-10), respectively. The comparable fi gures for all other patients were 3(0-19), 1(0-7) and 3(0-9), respectively (all p < 0.00005 vs varices). When comparing variceal bleeding patients with those who required intervention or died from another bleeding source, there was no difference using any of the three scores. In predicting need for intervention in the variceal bleeding group, AUC (95% CI) for GBS, admission Rockall and full Rockall scores were: 0.72 (0.56-0.89), 0.46 (0.30-0.62) and 0.66 (0.51-0.83), respectively. For predicting death, the fi gures were: 0.58 (0.41-0.75), 0.68 (0.54-0.82) and 0.72 (0.58-0.86), respectively. Conclusion At presentation, the GBS correctly identifi es patients with variceal bleeding as being at high risk for requiring intervention and appears superior to the admission Rockall score for this. However, it is a poor predictor of mortality in this patient group.