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Glasgow-Blatchford score for early risk stratification in upper gastrointestinal bleeding: Predicting blood
Manna Maria Theresa1, Prannoy George Mathen2, Kathyayini Vijayalakshmi Revivarman3
1Department of Emergency Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
Background:
Upper gastrointestinal bleeding (UGIB) remains a common medical emergency associated with significant morbidity and mortality. Early risk stratification is essential to identify patients who require urgent intervention. The Glasgow-Blatchford Score (GBS) is widely used to assess UGIB severity at presentation; however, data regarding its performance in the Indian population are limited. This study aimed to evaluate the ability of the GBS to predict the need for blood transfusion and early endoscopy among patients presenting with UGIB.
Methods:
A retrospective observational study was conducted at a tertiary care hospital in South India over a period of 2.5 years. Medical records of adult patients (18-80 years) presenting to the emergency department with clinical features of UGIB were reviewed. Demographic, clinical, and laboratory parameters required for calculating the GBS were collected. Statistical analysis included independent t-tests and Chi-square tests to evaluate associations between GBS and clinical outcomes. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoff values for predicting blood transfusion and early endoscopy.
Results:
A total of 100 patients were included, with a mean age of 59 ± 12 years, and 78% were male. Chronic liver disease was present in 61% of the cohort. Patients requiring blood transfusion had significantly higher GBS values compared with those who did not (P = 0.006). ROC analysis showed moderate predictive ability for blood transfusion (area under the curve [AUC] 67.8%) with an optimal cutoff score of 8 (sensitivity 86% and specificity 46%). For early endoscopy, the AUC was 71.8%, with a cutoff score of 9 (sensitivity: 80.6% and specificity: 54%).
Conclusion:
The GBS demonstrated significant predictive value for identifying patients with UGIB who are likely to require blood transfusion and early endoscopic evaluation. Incorporation of GBS into emergency department triage protocols may facilitate timely risk stratification and support evidence-based management of UGIB.
