raw data of CMRPG6F0371 Background: Emergency transfusion strategies for patients with upper gastrointestinal bleeding (UGIB) have not been well developed. The BISHE is a recently developed scoring system for massive transfusion but has not been validated. We evaluated the predictive ability of the BISHE score and that of a revised scoring system to improve care for patients with UGIB. Methods: This prospective study included patients who were admitted to our hospital between July 1, 2016 and June 30, 2019 and required massive transfusion (defined as receiving three units of red blood cells over one hour) in the emergency department. The predictive accuracy of the BISHE score and that of the revised scoring system were compared using area under the receiver-operating characteristic (AUROC) curve analysis. Results: Liver cirrhosis, an international normalized ratio >1.5, and hemoglobin <8.0 g/dL were independently associated (p<0.05) with massive transfusion. The revised scoring system discriminated successfully between patients with UGIB requiring massive transfusion and their counterparts who did not (AUROC 0.82, 95% confidence interval 0.78–0.86) and performed better than the BISHE score (AUROC 0.73, 95% confidence interval 0.69–0.76; p=0.004). Conclusions: Compared with the BISHE score, the revised scoring system was better able to identify patients likely to require massive transfusion.