Rockall Score

Scoring Criteria

Pre-endoscopy (max 7 pts): Age + Shock + Comorbidity

Post-endoscopy (add max 4 pts): Diagnosis + Stigmata of recent haemorrhage (SRH)

Total range: 0–11

Interpretation

Rates from Rockall et al. (1996) original derivation cohort (n=1625). Rates from score 0 and 1 are post-endoscopy.

Clinical Application

• Pre-endoscopy Rockall ≤3: Guides early discharge decisions when endoscopy has not yet been performed, though the Glasgow-Blatchford Score is generally preferred for this purpose.
• Complete (post-endoscopy) Rockall: Used to risk stratify after OGD for rebleeding risk and mortality, and to decide on inpatient observation duration and second-look endoscopy.
• Score 0 post-endoscopy: Very low rebleed rate (4.9%) and zero mortality — suitable for early discharge consideration.
• Score ≥5: Consider intensive care, repeat endoscopy within 24 hours, and early involvement of surgery/interventional radiology.
• Combined use with GBS is recommended: GBS for ED triage/discharge decisions, Rockall post-endoscopy for risk stratification.

Limitations

• Requires endoscopy findings for the full score — cannot be used solely for ED triage
• Outperformed by GBS for pre-endoscopy decision-making
• Does not account for anticoagulant/antiplatelet use
• Comorbidity component is subjective (e.g., what constitutes "any major comorbidity")
• Derived and validated primarily in a UK population — may need recalibration in other settings

References

1. Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316–321.
2. Blatchford O, et al. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–1321.
3. Laursen SB, et al. The Glasgow-Blatchford Score is the most accurate assessment of patients with upper-GI bleeding. Clin Gastroenterol Hepatol. 2012;10(10):1130–1135.
4. BSG. Guidelines on the management of acute upper gastrointestinal bleeding. Gut. 2019;68(Suppl 1):1–i57.

Related Calculators