Criteria
Risk assessment and scoring systems
Use validated scoring systems to help stratify patients who present to hospital with upper gastrointestinal bleeding. They can be used to help decide who needs urgent endoscopy (within 12 hours), who is stable enough to be admitted and have non-urgent endoscopy (within 24 hours), or who can be discharged from hospital.[34][35]
Glasgow-Blatchford score
Use the Glasgow-Blatchford score at first assessment to identify patients with low-risk bleeds who can be safely discharged without undergoing endoscopy.[31][32][33] [ Blatchford Score for Gastrointestinal Bleeding Opens in new window ]
If Glasgow-Blatchford score ≤1, consider managing the patient as an outpatient if safe and appropriate to do so. This approach is supported by latest evidence and in line with recommendations from the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy.[31][32]
Evidence shows that a Glasgow-Blatchford score ≤1 identifies a significantly higher proportion of low-risk patients compared with a Glasgow-Blatchford score of 0.[36][37]
Bear in mind that recommendations on discharge from the National Institute for Care and Health Excellence (NICE) in the UK (early discharge for patients with a pre-endoscopy Blatchford score of 0) are based on older evidence and therefore do not reflect current practice.[33]
Rockall score
Use the full Rockall score after endoscopy as recommended by NICE.[33] [ Rockall Score for Upper Gastrointestinal Bleeding Opens in new window ]
A score of ≤2 is associated with a low risk of further bleeding or death.
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