Rockall Score for Upper GI Bleeding (Pre-Endoscopy)

Why Use

Upper GI bleeding may present in different degrees of severity, from minor bleeding that can be managed outpatient to severe, life-threatening hemorrhage. The pre-endoscopy Rockall Score can help stratify which patients need endoscopy and intensive care. It is less accurate at identifying low-risk patients (e.g. those who may be treated as outpatients).

When to Use

Patients with clinical upper GI bleeding, prior to endoscopy.

Formula

Pearls / Pitfalls

The pre-endoscopy Rockall Score estimates mortality in patients with active upper GI bleed who have not had endoscopy. It is supported by multiple validation studies, most showing moderate prediction of death at higher risk. It can predict very low risk patients, but with less accuracy. The pre-endoscopy score is calculated based on clinical bleeding (i.e., without endoscopy results).

Management

Consider diagnostic endoscopy for patients with high risk of mortality from upper GI bleeding. Consider ICU level of care for patients who are hemodynamically unstable from upper GI bleeding. Note: The pre-endoscopy Rockall Score has not been shown to clearly identify individual patients who require intervention.

Critical Actions

Patients with a high mortality or risk of rebleeding should be considered for intervention and/or monitoring.

Advice

The Rockall Score predicts mortality better than does chance alone, but overall should be interpreted with caution—a score of ‘0’ in some studies suggested very low mortality, but in others was not a consistent indicator. Other scores such as the Glasgow-Blatchford Score may perform better, particularly for identifying very low risk patients. According to the American College of Gastroenterology’s management guidelines for patients with overt upper GI bleeding, neither the Rockall nor Glasgow-Blatchford scores can reliably predict which individual patients will need an intervention, except for patients with a Glasgow-Blatchford Score of 0 (< 1% chance of requiring intervention).

More Information

Score interpretation: Mortality rates, by pre-endoscopy score Score % Chance of mortality 0 0.2% 1 2.4% 2 5.6% 3 11% 4 24.6% 5 39.6% 6 48.9% 7 50% Adapted from Rockall et al. Comorbidities were defined as any of the following: Cardiac failure Ischaemic heart disease Asthma COPD Diabetes mellitus Rheumatoid arthritis Liver failure Renal failure Disseminated malignancy Other Pneumonia Dementia Recent major operation Malignancy CVA/TIA Haematological malignancy Hypertension Trauma/burns Other cardiac disease Major sepsis Other liver disease