Glasgow-Blatchford score: how the points are calculated

The Glasgow-Blatchford score is a point score for a person with bleeding from the upper gastrointestinal tract. It adds points for blood urea, haemoglobin (with separate scales for men and women), systolic blood pressure, heart rate, melena, syncope, hepatic disease and cardiac failure. The total runs from 0 to 23.

Not a medical device. Not a diagnosis or dosing recommendation.

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Blatchford O et al. · 2000
The Glasgow-Blatchford formula
Worked examples
Frequently asked questions

What is the Glasgow-Blatchford score?

The score was published by Blatchford, Murray and Blatchford in The Lancet in 2000. It's also called the Blatchford score or GBS. It uses two blood tests, two vital signs and four clinical findings.

This page explains the arithmetic. It doesn't turn a score into a recommendation, and it doesn't say what a score means for a particular person.

The Glasgow-Blatchford formula

GBS = urea points (0, 2, 3, 4 or 6)
    + haemoglobin points (sex-specific, 0 to 6)
    + systolic BP points (0 to 3)
    + heart rate ≥ 100 (1)
    + melena (1) + syncope (2) + hepatic disease (2) + cardiac failure (2)
maximum = 23

Exact expression the calculator uses:

GBS = urea_mmol_l table + haemoglobin_g_l table (sex-specific) + systolic_mm_hg table + (heart_rate_bpm >= 100) + melena + 2*syncope + 2*hepatic_disease + 2*cardiac_failure; max 23; score 0 low, else not_low

What each part means

Item	What earns points	Points
Blood urea (mmol/L)	Under 6.5	0
	6.5 to 7.9	2
	8.0 to 9.9	3
	10.0 to 24.9	4
	25.0 or more	6
Haemoglobin, men (g/L)	130 or more	0
	120 to 129	1
	100 to 119	3
	Under 100	6
Haemoglobin, women (g/L)	120 or more	0
	100 to 119	1
	Under 100	6
Systolic blood pressure (mm Hg)	110 or more	0
	100 to 109	1
	90 to 99	2
	Under 90	3
Heart rate	100 beats per minute or more	1
Melena	Present	1
Syncope	Present	2
Hepatic disease	Present	2
Cardiac failure	Present	2

How the score works

Urea. Find the urea band in mmol/L. If you have BUN in mg/dL, the calculator divides it by 2.8 first.
Haemoglobin. Use the men's or women's scale in g/L. If you have g/dL, the calculator multiplies by 10 first.
Systolic pressure. Lower pressure earns more points, up to 3.
Heart rate. 100 or more adds 1; 99 adds nothing.
Clinical findings. Melena adds 1. Syncope, hepatic disease and cardiac failure add 2 each.
Add them up. The total is 0 to 23.

Inputs come from the user

The record says the person using the calculator assigns melena, syncope, hepatic disease and cardiac failure as true/false answers. Magent's calculator doesn't examine anyone. It takes urea from 1 to 50 mmol/L or BUN from 3 to 140 mg/dL (one or the other, not both). It takes haemoglobin from 30 to 220 g/L or 3 to 22 g/dL, systolic pressure from 50 to 250 mm Hg and heart rate from 30 to 220. Points come from the unrounded converted values; the urea and haemoglobin it reports back are rounded to one decimal place.

Worked examples

These are the worked examples in Magent's record for the calculator.

Example 1: nothing scores

Urea 5.0 mmol/L is under 6.5 → 0.
A man with haemoglobin 140 g/L → 0. Systolic pressure 120 → 0. Heart rate 80 → 0.
No melena, syncope, hepatic disease or cardiac failure → 0.
Score = 0 out of 23.

Example 2: urea 25.0 mmol/L

Urea 25.0 mmol/L → 6.
Everything else is the same as Example 1 → 0.
Score = 6 out of 23.

Values at the boundaries

Each line changes one item from Example 1 (a man). All are Magent's expected values for the calculator.

Urea 6.5 → 2; urea 8.0 → 3; urea 10.0 → 4.
Haemoglobin 129 g/L → 1; 119 g/L → 3; 99 g/L → 6.
For a woman, haemoglobin 119 g/L → 1 and 99 g/L → 6.
Systolic pressure 109 → 1; 99 → 2; 89 → 3.
Heart rate 100 → 1.
BUN 14 mg/dL with haemoglobin 14.0 g/dL converts to urea 5.0 mmol/L and haemoglobin 140 g/L → 0.

History of the Glasgow-Blatchford score

The score comes from Blatchford O, Murray WR and Blatchford M, A risk score to predict need for treatment for upper-gastrointestinal haemorrhage, The Lancet, 2000 (volume 356, issue 9238, pages 1318–1321).

When it's used

Magent's record describes the calculator as for people with bleeding from the upper gastrointestinal tract.

Where it's used

Every input is a blood test, a vital sign or a clinical finding. The calculator doesn't take endoscopy findings.

Who uses it

The person using the calculator enters the lab values and vital signs and assigns the four findings. The calculator does the conversions and the adding.

Limits of the calculation

It adds up points. It doesn't find the cause of a bleed or say how severe it is.
It's the Blatchford 2000 score, not the Rockall score (full or pre-endoscopy) and not AIMS65.
Urea can be entered in mmol/L or as BUN in mg/dL, and haemoglobin in g/L or g/dL, but not both units at once.
This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

AIMS65 is a separate upper GI bleeding score with its own inputs.
Pre-endoscopy Rockall is the part of the Rockall score that can be added up before endoscopy. Its inputs differ from the Glasgow-Blatchford score's.

Glossary

Urea / BUN: a waste product measured in the blood. Urea is reported in mmol/L; BUN (blood urea nitrogen) in mg/dL.
Haemoglobin: the oxygen-carrying protein in red blood cells.
Melena: black, tarry stool from digested blood.
Syncope: fainting.

Common mistakes

Putting BUN in the urea field. BUN in mg/dL goes in its own field and is divided by 2.8.
Using the men's haemoglobin scale for a woman. For women, 100 to 119 g/L scores 1, not 3.
Giving heart rate 99 a point. The heart-rate point starts at 100.
Giving syncope 1 point. Syncope, hepatic disease and cardiac failure are 2 each; melena is 1.

Source

Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318-1321. DOI: 10.1016/S0140-6736(00)02816-6

Frequently asked questions

How do you calculate the Glasgow-Blatchford score?

Add the urea points, the haemoglobin points for the person's sex and the systolic pressure points. Then add 1 for heart rate of 100 or more, 1 for melena, and 2 each for syncope, hepatic disease and cardiac failure.

What does a Glasgow-Blatchford score of 0 mean?

It means none of the items earned a point. This page doesn't say what to do with any score; that depends on the person and the clinical context.

What is the highest Glasgow-Blatchford score?

23.

Can I enter BUN instead of urea?

Yes. The calculator takes BUN in mg/dL and divides it by 2.8 to get urea in mmol/L.

Who developed the Glasgow-Blatchford score?

Blatchford and colleagues, in a 2000 paper in The Lancet.