Questionnaire/history:

Syncope?

Melaena?

Past medical history?

- Liver disease?

- Cardiac failure?

Current medication?

Known drug allergies?

Examination:

Conscious level?

Blood pressure?

Pulse?

Temperature?

SpO2?

Respiratory rate?

Cardiac failure?

Investigations:

Haemoglobin?

Blood urea?

ECG?

Risk assessment:

Glasgow-Blatchford Score (GBS)

Blood urea (mmol/L)

6·5-7·9 = 2 points?

8·0-9·9 = 3 points?

10·0-25·0 = 4 points?

> 25·0 = 6 points?

Haemoglobin for men (g/L)

120-129 =1 points?

100-119 = 3 points?

< 100 = 6 points?

Haemoglobin for women (g/L)

100-119 =1 point?

< 100 = 6 point?

Systolic blood pressure (mm Hg)

100-109 = 1point?

90-99 = 2 point?

<90 = 3 point?

Other markers 

Pulse >= 100/min = 1 point?

Melaena = 1 point?

Syncope = 2 point?

Hepatic disease (known history or clinical and laboratory evidence (chronic or acute)) = 2 point?

Cardiac failure (known history or clinical and ECG evidence of cardiac failure) = 2 point?

Low-risk criteria on GBS (i.e. score = 0) are suitable for outpatient OGD within 24 hours if:

Urea < 6·5 mmol/L AND

Haemoglobin >= 130 g/L (men) or >= 120 g/L (women) AND

Systolic blood pressure >= 110 mm Hg AND

Pulse < 100 beats per min AND

Absence of melaena, syncope, cardiac failure or liver disease?

Management:

GBS score:

0 = low-risk: might be suitable for outpatient management

≥ 6 = 50% chance for the need of intervention

If no access to urgent blood test:

Referred urgently to hospital

Started fluids

Resource(s):

NICE 2016