Risk Stratification in Upper GI Bleeding

upper gi bleeding scores

Blatchford Score

Admission risk markerScore component value
Blood Urea (mg/dL)
18.2-22.42
22.4-283
28-704
>706
Haemoglobin (g/L) for men
12.0-12.91
10.0-11.93
10.06
Haemoglobin (g/L) for women
10.0-11.91
10.06
Systolic blood pressure (mm Hg)
100–1091
90–992
903
Other markers
Pulse ≥100 (per min)1
Presentation with melaena1
Presentation with syncope2
Hepatic disease2
Cardiac failure2

Urea and BUN Interconversion:

BUN (mg/dl) = Urea (mg/dl) / 2.14

Score is equal to “0” if the following are all present:

  • Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
  • Systolic blood pressure >109 mm Hg
  • Pulse ≤100/minute
  • Blood urea nitrogen level 6.5 mg/dL
  • No melena or syncope
  • No past or present liver disease or heart failure

Range of score is from 0 to 23 with high risk greater than 0.

Clinical Rockall Score

1. Age (years):

  • <60: 0
  • 60-79: 1
  • ≥80: 2

2. Shock:

  • HR >100/min: 1
  • SBP <100 mmHg, Ischemic heart disease, Congestive heary failure, any major comorbidity: 2
  • Renal failure, Liver failure, Metastatic malignancy: 3

Score >0 is regarded as high risk.

Rockall Score

Clinical + Endoscopic findings

Mnemonic: ABCDE

VariableScore 0Score 1Score 2Score 3
Age<6060- 79>80
BPNo shockPulse >100
BP >100 Systolic
SBP <100
Co-morbidityNil majorCHF, IHD, major morbidityRenal failure, liver failure, metastatic cancer
DiagnosisMallory-WeissAll other diagnosesGI malignancy
Evidence of bleedingNoneBlood, adherent clot, spurting vessel

A score less than 3 carries good prognosis but total score more than 8 carries high risk of mortality.

Forrest Classification (Endoscopic)

Forrest ClassificationRebleeding IncidenceSurgical RequirementIncidence of Death
Type I: Active Bleed
Ia: Spurting Bleed
Ib: Oozing Bleed
55-100%35%11%
Type II: Recent Bleed
Ila: Non-Bleeding Visible Vessel (NBVV)
Ilb: Adherent Clot
40-50%34%11%
20-30%10%7%
Type III: Lesion without Bleeding
Flat Spot
Clean Base
10%6%3%
5%0.5%2%

Medications used in Upper GI Bleeding:

Omeprazole: 80 mg bolus of omeprazole intravenously, followed by 8 mg/hr for 3 days.

Octreotide: Octreotide therapy should be empirically administered in patients with GIB and significant liver disease, a history of variceal bleeding, a history of alcoholism, or highly abnormal liver function tests. The recommended dose of octreotide is a 50-μg bolus followed by 50 μg/hr intravenously.

Source: Rosen’s Emergency Medicine Concept and Clinical Practice – 8th edition

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