How it's calculated
Age, shock status, and comorbidity give a pre-endoscopy (clinical) score of 0-7. Adding endoscopic diagnosis and stigmata of recent haemorrhage gives the full post-endoscopy score of 0-11.
Risk interpretation (full score)
| Full Rockall score | Risk |
|---|---|
| 0-2 | Low risk |
| 3-5 | Moderate risk |
| ≥6 | High risk |
Clinical use
- The clinical (pre-endoscopy) score can be calculated immediately at presentation to help triage urgency of endoscopy and level of care.
- The full post-endoscopy score is a better predictor of rebleeding and mortality and is used once endoscopic findings are available.
- A low clinical score alone has been used to support consideration of early discharge in some pathways, though local protocols and overall clinical judgement should guide this decision.
- The Glasgow-Blatchford Score is a commonly used alternative that does not require endoscopic findings and is often preferred for initial triage before endoscopy.
Frequently asked questions
What is the Rockall Score used for?
It estimates the risk of rebleeding and mortality after upper gastrointestinal bleeding, using clinical features alone (pre-endoscopy) or combined with endoscopic findings (full score).
What is the difference between the clinical and full Rockall score?
The clinical score (age, shock, comorbidity) can be calculated immediately; the full score adds endoscopic diagnosis and stigmata of recent haemorrhage, giving better prediction once endoscopy has been performed.
How does this compare to the Glasgow-Blatchford Score?
Glasgow-Blatchford doesn't require endoscopy and is often used for initial triage and to identify very-low-risk patients for possible outpatient management, while Rockall (especially the full score) better predicts rebleeding and mortality after endoscopy.
What does a high Rockall score mean?
It indicates substantially higher risk of rebleeding and mortality, generally prompting closer monitoring, higher level of care, and more cautious discharge planning.
References
- Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-321.
- Barkun AN, et al. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360.