Rockall Score for Upper GI Bleeding (Complete)

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 complete 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 who have undergone endoscopy.

Formula

Pearls / Pitfalls

The complete Rockall Score estimates mortality in patients with active upper GI bleed who have had endoscopy. Use the pre-endoscopy Rockall Score for patients with upper GI bleed who have not undergone endoscopy. The Rockall Score 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 complete Rockall Score is calculated based on clinical bleeding AND 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.

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: Rebleeding and mortality rates, by complete risk score Score Rebleed Deaths (total) 0 4.9% 0% 1 3.4% 0% 2 5.3% 0.2% 3 11.2% 2.9% 4 14.1% 5.3% 5 24.1% 10.8% 6 32.9% 17.3% 7 43.8% 27% ≥8 41.8% 41.1% 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