Gastroenterology
Rockall Score (pre-endoscopy)
Risk after upper GI bleeding (clinical score).
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The Rockall score risk-stratifies patients after acute upper gastrointestinal (GI) haemorrhage, predicting rebleeding and death. The pre-endoscopy (clinical) version uses three readily available variables — age, evidence of shock and major comorbidity — to give a score before endoscopy is performed. The full Rockall score adds two endoscopic items (the diagnosis and any stigmata of recent haemorrhage), producing a more complete prediction. The clinical component scores up to 7 and is intended for rapid bedside triage.
Interpreting the result
Higher scores indicate greater risk of rebleeding and mortality. A clinical score of 0 identifies a low-risk group who may be suitable for an early-discharge pathway after senior review; scores of 1–3 are intermediate; and scores of 4 or more flag higher-risk patients who warrant admission, close monitoring and prompt endoscopy. The thresholds guide intensity of monitoring rather than dictating a fixed disposition, and should always be combined with the full clinical picture.
Advice
The full Rockall score (adding diagnosis and stigmata at endoscopy) better predicts rebleeding and mortality. Use with the Glasgow-Blatchford score and local guidance.
Worked example
An 82-year-old presents with haematemesis, a heart rate of 105/min, systolic blood pressure of 95 mmHg and a history of ischaemic heart disease: Age ≥80 (2) + Hypotension (2) + Cardiac comorbidity (2) = 6. This is a higher-risk patient who needs admission, resuscitation and urgent endoscopy.
Pearls / pitfalls
- The pre-endoscopy (clinical) score cannot give a score of 0 to anyone aged 60 or over, so very few older patients fall into the lowest-risk band.
- It predicts rebleeding and death, not the immediate need for endoscopy — the Glasgow-Blatchford score is generally preferred for deciding who can avoid admission.
- A complete (post-endoscopy) Rockall score is more accurate; do not rely on the clinical score alone once endoscopy has been performed.
- Resuscitation and correction of shock take priority over score calculation in an actively bleeding patient.
Evidence & validation
Derived and validated by Rockall and colleagues in a UK national audit of acute upper GI bleeding, and widely used alongside the Glasgow-Blatchford score in British and international guidance for risk assessment after upper GI haemorrhage.
Frequently asked questions
What is the difference between the clinical and full Rockall score?
The clinical (pre-endoscopy) score uses age, shock and comorbidity only. The full score adds the endoscopic diagnosis and any stigmata of recent haemorrhage, giving a more accurate prediction of rebleeding and death.
Is Rockall or Glasgow-Blatchford better for deciding admission?
For identifying very-low-risk patients who might avoid admission and early endoscopy, the Glasgow-Blatchford score is generally preferred. Rockall is more focused on predicting rebleeding and mortality, particularly once endoscopy has been done.
What counts as shock for this score?
Tachycardia with a heart rate of 100/min or more (but a systolic blood pressure of at least 100 mmHg) scores one point, and hypotension with a systolic blood pressure below 100 mmHg scores two.
Can a low score mean early discharge?
A clinical score of 0 supports an early-discharge pathway after senior assessment, but this decision also depends on resuscitation status, comorbidities and social factors, and should follow local policy.
References
- Rockall TA, Logan RFA, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316–321.
- NICE NG12 (formerly CG141): Acute upper gastrointestinal bleeding in over 16s: management.
About the creator
Rockall TA et al.
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