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Rockall Score

Rockall Score — Upper GI Bleeding

Predicts rebleeding risk and mortality after UGIB. Pre-endoscopic (3 variables) or full post-endoscopic (5 variables). Full score ≤ 2 permits safe early discharge.

Pre-Endoscopy Variables

Age

Shock Status

Comorbidity

Post-Endoscopy Variables (optional)

Endoscopic Diagnosis

Endoscopic Stigmata of Haemorrhage

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Prognostic assessment of patients after undergoing endoscopy for acute upper gastrointestinal bleeding (UGIB)

To calculate the risk of mortality and re-bleeding in a hospital setting

Used specifically post-endoscopy (Full Rockall Score) to guide continued inpatient care vs. safe discharge

Full vs. Pre-Endoscopic Score

The "Pre-Endoscopic" Rockall relies only on age, shock, and comorbidity. However, the "Full Rockall Score" adds the definitive endoscopic diagnosis and stigmata of recent hemorrhage, providing a significantly more accurate prognosis.

Section 2

Formula & Logic

Scoring Components (0–11 pts)

Age: Higher risk in elderly (> 60 and > 80 yrs).

Shock: Based on heart rate and blood pressure.

Comorbidities: Renal failure, Hepatic failure, or Disseminated Malignancy.

Diagnosis: Mallory-Weiss (Low) vs. Peptic Ulcer vs. GI Malignancy (High).

Stigmata of Haemorrhage: Visible vessel or spurting blood in the ulcer base.

Mortality Prediction

Score ≤ 2	매우 Low Risk (~0.1% Mortality)
Score 3–5	Moderate Risk (4–10% Mortality)
Score ≥ 8	High Risk (> 40% Mortality)

Section 3

Pearls/Pitfalls

Rockall vs. GBS

The Glasgow-Blatchford Score (GBS) is better for evaluating patients *before* endoscopy (to decide who can go home from the ED). The Rockall Score is better for evaluating patients *after* endoscopy (to decide who is at risk of dying or re-bleeding during the admission).

The comorbidity weight

The Rockall score heavily penalizes multi-organ failure. A patient with renal and hepatic failure automatically receives a high score (starting at 6 points) because they lack the physiological reserve to tolerate a secondary re-bleed event.

Clinical Pearls

Score ≤ 2 has a re-bleeding risk of < 5%, making these patients candidates for early discharge post-procedure

A pulse > 100 bpm is considered "shock" even if the blood pressure is normal (compensated state)

Stigma of spurting/vessel (Forrest Ia-IIa) adds 2 points, emphasizing the importance of endoscopic findings

Section 4

Next Steps

Management Action

Score ≤ 2: Consideration for outpatient follow-up after therapeutic endoscopy.

Score ≥ 3: Hospitalize for at least 72 hours of monitoring and high-dose IV PPI.

Complementary Scoring

Glasgow-Blatchford Score (Pre-endoscopy triage)

Forrest Classification (Stigmata only)

AIMS65 Score (Mortality Focus)

Section 5

Evidence Appraisal

The Foundational Score

Risk assessment after acute upper gastrointestinal haemorrhage.

Rockall TA et al. • Gut. 1996;38(3):316-21. The seminal validation in over 4,000 UK patients.

View Source

Section 6

Literature

T.A. Rockall

Developed by Timothy Rockall and colleagues in London. It was born out of the UK National Comparative Audit of Upper Gastrointestinal Haemorrhage, which aimed to standardize the widely varying mortality rates across British hospitals.

Last Comprehensive Review: 2026

Related Gastroenterology Tools

Glasgow-Blatchford Score

AIMS65 Score

Forrest Classification

Ranson Criteria

BISAP Score

Harvey-Bradshaw Index

Crohn's Disease Activity Index

Mayo Score

Truelove & Witts Criteria

Adenoma Detection Rate

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