Rockall Score
Predicts hemorrhage mortality risk based on clinical patient data.
Read more about this upper GI bleeding score and about the original study in the text below the calculator.
The Rockall score stratifies mortality risk in patients at risk of upper gastrointestinal bleeding.
It is based on patient data such as presentation with shock symptoms, comorbidities or results of endoscopic diagnosis.
The final result is based on the sum of the five items and has values between 0 and 12.
Scores below 3 are classed as low risk whilst scores above 3 indicate that the patient is at high risk for both rebleeding and mortality.
| Score | Rebleeding rate | Mortality |
| 0 - 2 | 3.50 - 5.30% | 0 - 0.20% |
| 3 | 11.20% | 2.90% |
| 4 | 14.10% | 5.30% |
| 5 | 24.10% | 10.80% |
| 6 | 32.90% | 17.30% |
| 7 | 43.80% | 27% |
| 8 - 12 | 41.80% | 41.10% |
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The scoring system explained
This is a mortality risk predictor addressed to patients who are diagnosed with upper gastrointestinal bleeding and can help clinicians devise best management (i.e. endoscopic or surgical).
The five items considered in the score are presented in the table below:
| Rockall score item | Answer choices (points) |
| Age | Under 60 years (0) 60 to 79 years (1) 80 years or above (2) |
| Shock symptoms | Shock absent, normal heart rate and BP (0) Heart rate 100 or higher (1) Systolic BP <100 mmHg (Heart rate 100 or higher) (2) |
| Comorbidity | None (0) CHF, CAD or other major comorbidity (2) Renal Failure, liver failure or metastatic cancer (3) |
| Endoscopic diagnosis | No lesion and no stigmata of recent hemorrhage or Mallory-Weiss tear (0) All other upper GI bleeding causes (1) Upper gastrointestinal tract cancer (2) |
| Stigmata of recent GI bleeding | No stigmata or dark spot only (0) Blood in upper GI tract, adherent clot, visible vessel, or actively bleeding or spurting vessel (3) |
Age is one of the GI bleeding risk factors. The presence of comorbidities (especially cardiac and digestive conditions) increases haemorrhage risk.
The comorbidities referred to in the score can be found in this table:
| Cardiac failure | COPD | Diabetes mellitus |
| Ischaemic heart disease | Asthma | Rheumatoid arthritis |
| CVA/TIA | Pneumonia | Malignancy |
| Hypertension | Liver failure | Disseminated malignancy |
| Other cardiac disease | Other liver disease | Dementia |
| Haematological malignancy | Renal failure | Trauma/burns |
| Recent major operation | Major sepsis |
Taking the above in account, a presentation with low risk would have the following characteristics:
■ No shock symptoms with a normal heart rate;
■ No comorbidities;
■ No lesion or stigmata of recent hemorrhage or very little indication;
■ No blood, clots or visible vessels in the upper GI tract.
In comparison to the other upper GI bleeding risk score, the Glasgow Blatchford scoring system, the Rockall score was criticised for criteria that is more subjective and that tends to allow the clinician too much space in evaluating the severity of the patient condition.
However, the two scores are different in terms of where the evaluation is focused, the GBS looks at clinical presentation and symptoms whilst Rockall is focused on patient general status.
Result interpretation
This upper GI bleeding risk score provides a different weight to answers to both clinical criteria and endoscopic findings. These points are summed to provide the final answer which ranges from 0 to 12, where the higher the score, the higher the rebleeding and mortality risk.
The following table correlates the scores with their outcome prediction:
| Score | Rebleeding rate | Mortality |
| 0 - 2 | 3.50 - 5.30% | 0 - 0.20% |
| 3 | 11.20% | 2.90% |
| 4 | 14.10% | 5.30% |
| 5 | 24.10% | 10.80% |
| 6 | 32.90% | 17.30% |
| 7 | 43.80% | 27% |
| 8 - 12 | 41.80% | 41.10% |
Scores below 3 are classed as low risk whilst scores above 3 are classed as high risk, meaning that the patient is at significant risk of both rebleeding and mortality.
About the study
The score was designed in 1996, by Rockall et al. following a study on a cohort of 4185 subsequent patients diagnosed with acute upper gastrointestinal haemorrhage during a four month period and another cohort of 1625 patients identified over a three month period.
Using multiple logistic regression, the five factors currently in the score were found to be independent predictors of mortality.
Other risk factors that were looked at during the study but that weren’t represented in the final model include: hemoglobin, gender, presentation different from shock, drug therapy with NSAIDs and anticoagulants.
The numerical score created was found to be accurate in categorizing patients with UGIB based on risk of death.
The study also found that the risk score:
■ Could identify 15% of all cases with acute upper GI haemorrhage at presentation;
■ Could identify 26% of cases after endoscopy who are at low risk and can receive outpatient treatment.
Upper GI bleeding guidelines
UGIB is considered a medical emergency and requires rapid intervention after timely risk assessment.
The faster therapy is initiated (endoscopy therapy such as clips, thermocoagulation, epinephrine injections, surgery), the less chances of transfusion to be needed or of medical complications.
The risk factors for UGIB include:
■ Helicobacter Pylori infection (present in 64% of cases);
■ Adheres to gastric epithelium, predisposing underlying mucosa to injury by toxins;
■ Aspirin or NSAID use;
■ Elder age (especially over 70);
■ Male gender (twice as common as female).
There are several GI conditions in which there is a high risk of erosions into larger vessels which means there is a risk of massive hemorrhage or of diffuse bleeding that won’t stop even after intervention.
Some of these conditions are included in this table:
| Peptic Ulcer Disease | Arteriovenous malformation |
| Gastric Ulcer | Esophageal Varices |
| Duodenal Ulcer | Mallory-Weiss tear |
| Gastritis or Duodenitis | Gastrointestinal malignancy |
| Cirrhosis | Chronic Renal Failure |
Original source
Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996; 38(3):316-21.
Validation
1. Kim BJ, Park MK, Kim SJ, Kim ER, Min BH, Son HJ, Rhee PL, Kim JJ, Rhee JC, Lee JH. Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study. Dig Dis Sci. 2009; 54(11):2523-9.
2. Vreeburg E, Terwee C, Snel P, Rauws E, Bartelsman J, Meulen J, Tytgat G. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999; 44(3): 331–335.
Specialty: Gastroenterology
System: Digestive
Objective: Risk Stratification
Type: Score
No. Of Items: 5
Year Of Study: 1996
Article By: Denise Nedea
Published On: June 4, 2017 · 02:05 PM
Last Checked: June 4, 2017
Next Review: June 4, 2023