A Glasgow-Blatchford score of 0 or 1 identifies patients with upper gastrointestinal bleeding at very low risk of needing intervention or dying. Such patients can usually be managed as outpatients with early endoscopy arranged.
The score uses urea, haemoglobin, systolic pressure, pulse, melaena, syncope, hepatic disease and cardiac failure, all available at the bedside.
- Calculate the Glasgow-Blatchford score for every patient with suspected upper GI bleeding.
- Consider outpatient management with early endoscopy for scores of 0 or 1.
- Use a restrictive transfusion threshold, around 70 to 80 g/L, in most patients without cardiovascular disease.
- Give a proton pump inhibitor after endoscopic therapy for high-risk ulcer stigmata.
Why it matters
It frees beds and endoscopy slots for the patients who need urgent care.
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