Clinical Utility of Glasgow-Blatchford Score in Patients Presenting with Acute Upper Gastrointestinal Bleed to the Emergency Department in A Tertiary Care Centre in South India

INTRODUCTION: The Glasgow-Blatchford Score (GB Score) is a validated screening tool used to predict the need for therapeutic interventions, such as blood transfusion and early endoscopy, in patients presenting to the emergency department (ED) with upper gastrointestinal bleeding (UGIB). However, there is limited research regarding the optimal GB Score cut-off values for predicting these interventions in the Indian population. OBJECTIVES: This study aims to Compare GB score with the need for Blood Transfusion and to determine the cut-off GB scores that predict the need for blood transfusion and early endoscopy in this population. MATERIALS AND METHODS: Retrospective comparative study done among 100 patients who presented to the ED with Upper GI bleed. Mean GB Score was compared among patients that required blood transfusion (50) and those that did not (50) and association of GB Score and need of blood transfusion and early endoscopy was found and a cut off score was calculated using ROC curve.(1,2) RESULTS: The mean GB Score was significantly higher in patients who received blood transfusions compared to those who did not (p<0.001), with a large effect size of 0.93. There was a statistically significant association between GB Score and blood transfusion (p=0.006), with an effect size of 0.27. The ROC curve for blood transfusion had an AUC of 67.8%, and the cut-off GB Score for predicting the need for transfusion was found to be 8 (p=0.002) with a sensitivity of 86% and specificity of 46%. A significant association was found between GB Score and early endoscopy (p=0.001), with an effect size of 0.32. The cut-off GB Score for predicting the need for early endoscopy was found to be 9 (p=0.001) with 80.6% sensitivity and 54% specificity. DISCUSSIONS/CONCLUSIONS: The findings suggest that a GB Score cut-off score of 8 for blood transfusion and 9 for early endoscopy can effectively predict the need for these interventions in patients with UGIB in the Indian population. Referring patients to a center with blood bank and endoscopy facilities is made easier by calculating the GB score in peripheral centers. Early intervention based on these scores may be associated with better clinical outcomes, including reduced need for invasive ventilation and lower in-hospital mortality. Larger RCTs are needed to confirm the results.