This study involves a large gastrointestinal (GI) bleeding cohort of almost 2000 patients, in whom the authors have shown that a value of 0 or 1 on an easy-to-use tool (the modified Blatchford risk score [mBRS]) has a high negative predictive value for rebleeding and death, as well as for high-risk stigmata on endoscopy. Unlike other GI bleeding risk scores (eg, Rockall score), one does not need endoscopy to complete the mBRS score, which comprises simple factors such as hemoglobin, vital signs, comorbidities, and presence of melena. It can therefore potentially be used on the frontlines by nonendoscopists, especially after-hours, to consider discharge pending urgent outpatient endoscopy in approximately 10% of patients. It also performs much better than the clinical (nonendoscopic) component of the conventional Rockall score for this purpose. Specifically, an mBRS of 1 or lower was associated with lower rebleeding (5% vs 19%; P<.001) and mortality (0.5% vs 5.8%; P = .003) and was significant in a multivariate analysis (correcting for medical and endoscopic therapies) for both rebleeding (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.1-0.5) and mortality (OR, 0.1; 95% CI, 0.02-0.9). High-risk stigmata were also less frequent when the mBRS was 1 or lower (17% vs 33%; OR, 0.4; 95% CI, 0.3-0.6). Even the patients with a low mBRS who had apparently been documented to have high-risk stigmata had a low rebleeding rate (3%) and, consequently, a lower apparent benefit from endoscopic therapy.