Rockall Score
Evaluates the risk of mortality and rebleeding after an acute upper gastrointestinal hemorrhage.
The Rockall Score: Evaluation of GI Bleeding
The Rockall Score was developed in 1996 to identify patients at risk of an adverse outcome (rebleeding and mortality) following an episode of acute upper gastrointestinal bleeding (UGIB). It is particularly useful in gastroenterology and the emergency department to guide early management.
Structure and Use of the Score
The full score (out of a maximum of 11 points) requires the results of endoscopy. However, there is a "Clinical Rockall Score" (or pre-endoscopic, out of 7 points) based solely on age, hemodynamics, and comorbidities, useful for initial triage.
- Score < 3 (Low risk): Very good prognosis. These patients can often benefit from early discharge or outpatient management after endoscopy.
- Score 3 to 4 (Intermediate risk): Require standard hospitalization and close monitoring.
- Score ≥ 5 (High risk): Significant risk of rebleeding (> 20%) and mortality. Justifies ICU admission, expert therapeutic endoscopy, and aggressive medical treatment (e.g., high-dose PPIs).
Limitations and Alternative Scores
Although highly validated, the Rockall Score is sometimes criticized because it requires endoscopy to be complete. In the emergency room, to decide on immediate admission or discharge *before* endoscopy, the Glasgow-Blatchford Score (GBS) is often preferred as it relies solely on clinical and laboratory parameters.
Risk Stratification (Complete Score)
| Total Score | Rebleeding Risk | Estimated Mortality |
|---|---|---|
| 0 - 2 pts | < 5 % | 0.1 - 0.2 % |
| 3 - 4 pts | 10 - 15 % | 3 - 5 % |
| ≥ 5 pts | 24 - 40 % | 11 - 39 % |
References:
1. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-21.
[NIH - PubMed]
2. Vreeburg EM, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999;44(3):331-5.
[BMJ - Gut Journal]
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