What Glasgow-Blatchford score is safe for discharge?

A Glasgow-Blatchford score of 0 or 1 identifies patients at very low risk of needing a transfusion, endoscopic treatment or surgery, or of dying. International and European (ESGE 2021) guidance supports managing these patients as outpatients without urgent endoscopy. Any higher score needs admission and assessment.

Does the Glasgow-Blatchford score need endoscopy?

No. The Glasgow-Blatchford score uses only the urea, haemoglobin, systolic blood pressure, pulse and four clinical features, so it can be calculated at the front door before any endoscopy. The Rockall score, by contrast, needs endoscopic findings for its full version.

Glasgow-Blatchford score calculator: upper GI bleed

Creator: Dr. Mohammed Maree
Published: 2026-11-03
License: https://creativecommons.org/licenses/by-nc/4.0/

Written and clinically reviewed by Dr. Mohammed Maree, consultant minimally invasive and bariatric surgeon, Al-Makassed Hospital, Jerusalem, and Assistant Professor of Surgery, Al-Quds University. Last updated 3 November 2026.

Enter the results

Urea

Unit

Haemoglobin

Unit

Sex

Systolic BP (mmHg)

Pulse (per minute)

Clinical features

Presented with melaena+1Presented with syncope+2Known liver diseaseChronic disease, or clinical or laboratory evidence of it+2Known heart failureChronic disease, or clinical or laboratory evidence of it+2

The score

Item	Value	Points
Urea (mmol/L)	Below 6.5	0
	6.5–7.9	2
	8.0–9.9	3
	10.0–24.9	4
	25 or more	6
Haemoglobin, men (g/dL)	13 or more	0
	12.0–12.9	1
	10.0–11.9	3
	Below 10	6
Haemoglobin, women (g/dL)	12 or more	0
	10.0–11.9	1
	Below 10	6
Systolic BP (mmHg)	110 or more	0
	100–109	1
	90–99	2
	Below 90	3
Pulse	100 or more	1
Melaena	Present	1
Syncope	Present	2
Liver disease	Present	2
Heart failure	Present	2

The calculator converts a BUN in mg/dL to urea in mmol/L by multiplying by 0.357, and haemoglobin in g/L to g/dL by dividing by 10.

Why urea rises in an upper GI bleed

Blood in the stomach and duodenum is digested and its protein absorbed, so the liver makes more urea. A rising urea with a normal creatinine is a clue that the bleeding is from the upper GI tract. Hypovolaemia then adds a pre-renal rise on top.

A worked example

A 64-year-old man with melaena. Urea 11.2 mmol/L (4), haemoglobin 10.8 g/dL (3), systolic BP 104 (1), pulse 104 (1), melaena (1). GBS 10: high risk. Admit, resuscitate, cross-match and arrange endoscopy within 24 hours, sooner if he becomes unstable.

Glasgow-Blatchford versus Rockall

The Glasgow-Blatchford score is used before endoscopy, to decide who needs admission and intervention. The Rockall score is completed after endoscopy and predicts rebleeding and death. NICE CG141 recommends both: Blatchford at first assessment, full Rockall after endoscopy.

References

Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356:1318–21.
NICE CG141. Acute upper gastrointestinal bleeding in over 16s: management. 2012 (updated 2016).
Gralnek IM, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: ESGE Guideline update 2021. Endoscopy 2021;53:300–32.
Stanley AJ, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding. BMJ 2017;356:i6432.

Educational use

This calculator is a teaching aid. It does not replace clinical judgement, senior advice or your local guidelines.

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Glasgow-Blatchford score calculator