216768 referral many thanks for this referral full stop coffee ground vomiting alone without melena or hemoglobin drop has negative predictive value for need for endoscopic intervention full stop with a glasgow baxter score of 0, I think that gi bleeding is unlikely and you should investigate the cause of vomiting of stagnant stomach contents I e intercurrent illness, gastric outlet obstruction, bowel obstruction etcetera instead of investigating for gi bleeding in the first instance full stop happy to discuss