Upper GI Bleed (UGI Bleed) Scoring : Mnemonics

upper gi bleeding scores

Blatchford Score

Blatchford score is recommended by NICE for 1st assessment.

Admission risk markerScore component value
Blood Urea (mg/dL)
Haemoglobin (g/L) for men
Haemoglobin (g/L) for women
Systolic blood pressure (mm Hg)
Other markers
Pulse ≥100 (per min)1
Presentation with melaena1
Presentation with syncope2
Hepatic disease2
Cardiac failure2
BUN (mg/dl) = Urea (mg/dl) / 2.14

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

Mnemonic: A-B-C-D-E-F

  • Active patients with syncope or who have melena
  • BUN – elevation of ≥ 6.5 mg/dL
  • Circulation – systolic blood pressure of ≥ 110 mm Hg
  • Drop” in hemoglobin – for men and women, this is ≤ 12.9 g/dL and ≤ 11.9 g/dL, respectively
  • Elevated” – pulse rate ≥ 100 pulses/min
  • Failure – cardiovascular or liver disease

Score interpretation:

  1. 0: Low risk
  2. >0: High risk (medical intervention, transfusion, endoscopy or surgery)
  3. 8 or more: ICU admission

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

Rockall score must be assessed pre-endoscopy and post-endoscopy.

Clinical + Endoscopic findings

Mnemonic: ABCDE

VariableScore 0Score 1Score 2Score 3
Age<6060- 79>80 
BPNo shockPulse >100
BP >100 Systolic
SBP <100 
Co-morbidityNil major CHF, IHD, major morbidityRenal failure, liver failure, metastatic cancer
DiagnosisMallory-WeissAll other diagnosesGI malignancy 
Evidence of bleedingNone Blood, 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
Type II: Recent Bleed
Ila: Non-Bleeding Visible Vessel (NBVV)
Ilb: Adherent Clot
Type III: Lesion without Bleeding
Flat Spot
Clean Base

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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