Application and Internal Validation of the Modified Glasgow-Blatchford Score for Early Triage of Acute Upper Gastrointestinal Bleeding.
TL;DR
The modified Glasgow-Blatchford score may support a more standardized objective approach to early triage, but the remaining false-negative cases indicate that it should be used as an adjunct to clinical assessment rather than as a stand-alone discharge tool.
Abstract
Acute upper gastrointestinal bleeding requires early risk stratification to identify patients who may need urgent intervention while avoiding unnecessary hospitalization among low-risk cases. This retrospective single-center cohort study evaluated the modified Glasgow-Blatchford score as an objective triage tool in comparison with the original Glasgow-Blatchford score. A total of 366 consecutive patients with acute upper gastrointestinal bleeding were included. Clinical presentation, initial vital signs, and the earliest laboratory results obtained at presentation were used to calculate both scores. The primary high-risk outcome was a composite of in-hospital blood transfusion, therapeutic endoscopy, surgery, or death. Using a predefined low-risk threshold of ≤1, diagnostic performance was evaluated overall and in variceal and non-variceal subgroups. Overall, 151 of 366 patients (41.26%) met the composite high-risk outcome, and 18 patients (4.92%) died during hospitalization. At the predefined threshold, the modified score showed higher sensitivity, specificity, positive predictive value, negative predictive value, and agreement than the original score, with the greatest gains observed in specificity (45.58% vs. 40.00%) and negative predictive value (98.00% vs. 94.51%). The modified score classified 9 additional patients as low risk and reduced false-negative low-risk classifications from 5 cases to 2 cases. Specificity was also higher in both bleeding-etiology subgroups. Mortality discrimination was more favorable for the modified score, although this finding should be interpreted cautiously because only 18 deaths occurred. These findings suggest that the modified Glasgow-Blatchford score may support a more standardized objective approach to early triage, but the remaining false-negative cases indicate that it should be used as an adjunct to clinical assessment rather than as a stand-alone discharge tool.