Rockall Score Calculator
Calculate pre-endoscopy and post-endoscopy Rockall scores for risk stratification in upper gastrointestinal bleeding. Assess rebleeding risk and mortality to guide management.
Calculate Rockall Score
Pre-Endoscopy Variables
Post-Endoscopy Variables (Add after endoscopy)
Pre-Endoscopy Risk Assessment
Post-Endoscopy Risk Assessment
Risk Stratification by Score
| Complete Score | Risk Level | Rebleeding | Mortality |
|---|---|---|---|
| 0-2 | Low | 4-5% | 0.2% |
| 3-4 | Moderate | 11-14% | 2.4% |
| 5-6 | High | 24-30% | 10.8% |
| 7-11 | Very High | 42-44% | 26.7% |
Management by Risk Category
Low Risk (Score 0-2)
- •Consider outpatient management or early discharge (<24 hours)
- •PPI therapy (oral acceptable)
- •Ensure follow-up arranged
- •Patient education about warning signs
Moderate Risk (Score 3-4)
- •Inpatient monitoring (standard ward acceptable)
- •IV PPI therapy initially, transition to oral
- •Serial hemoglobin monitoring
- •Discharge when stable, typically 2-3 days
High Risk (Score 5-6)
- •ICU or step-down unit monitoring
- •High-dose IV PPI (bolus then infusion)
- •Close monitoring for rebleeding
- •Surgery/IR consult for potential intervention
- •Consider repeat endoscopy if rebleeding
Very High Risk (Score 7-11)
- •ICU admission required
- •High-dose IV PPI infusion
- •Early surgery/IR consult
- •Consider prophylactic second-look endoscopy
- •Aggressive resuscitation, blood product availability
- •Discuss advance care planning if appropriate
Understanding the Rockall Score
Development and Validation
The Rockall score was developed in 1996 by T.A. Rockall and colleagues to predict mortality and rebleeding risk in patients with upper gastrointestinal bleeding. It has been extensively validated and remains one of the most widely used scoring systems for risk stratification in UGIB.
Components
The Rockall score has two versions:
- Pre-endoscopy (clinical) score: Uses age, shock, and comorbidities. Maximum 7 points. Can be calculated immediately on presentation.
- Complete (post-endoscopy) score: Adds endoscopic diagnosis and stigmata of hemorrhage. Maximum 11 points. More accurate for risk prediction.
Clinical Applications
- Identify low-risk patients (score 0-2) suitable for early discharge or outpatient management
- Predict need for intervention (endoscopic, surgical, or radiologic)
- Determine appropriate level of care (ICU vs ward)
- Stratify patients for clinical trials
- Guide transfusion and PPI therapy intensity
Advantages
- Well-validated across multiple populations
- Pre-endoscopy score allows early risk stratification
- Identifies low-risk patients who may avoid hospitalization
- Easy to calculate with readily available variables
- Predicts both rebleeding and mortality
Limitations
- Developed before routine use of proton pump inhibitors
- Some subjectivity in assessing "major comorbidity"
- Less accurate in patients on anticoagulation
- Does not account for hemoglobin level or need for transfusion
- Glasgow-Blatchford score may be better for predicting need for intervention
General Management of UGIB
- Resuscitation: Two large-bore IVs, crystalloid, blood products as needed. Avoid over-resuscitation (target Hgb 7-9 g/dL in most patients).
- PPI therapy: High-dose IV initially (e.g., pantoprazole 80mg bolus then 8mg/hr infusion), transition to oral when stable.
- Endoscopy: Within 24 hours for most patients. Earlier (within 12 hours) for high-risk features.
- Hemostasis: Endoscopic therapy (clips, thermal, injection) for high-risk lesions.
- Risk modification: H. pylori testing and treatment. NSAID cessation. Antiplatelet/anticoagulation management.
Frequently Asked Questions
What is the Rockall score used for?
The Rockall score predicts mortality and rebleeding risk in patients with upper GI bleeding. It helps determine the appropriate level of care, identify candidates for early discharge, and guide management intensity.
When should I calculate the pre-endoscopy vs post-endoscopy score?
The pre-endoscopy (clinical) score can be calculated immediately on patient presentation using age, shock, and comorbidities. The complete score requires endoscopy findings and provides more accurate risk prediction for final disposition decisions.
Can patients with score 0-2 really be discharged?
Studies show that patients with complete Rockall score 0-2 have very low mortality (0.2%) and rebleeding risk (4-5%). These patients may be candidates for early discharge or outpatient endoscopy, but clinical judgment is essential. Consider hemoglobin stability, social factors, and ability to return if symptoms worsen.
What are "stigmata of recent hemorrhage"?
High-risk stigmata include: active arterial spurting, visible vessel, adherent clot, and fresh blood in upper GI tract. Low-risk stigmata include: flat pigmented spot or clean-based ulcer. These findings guide endoscopic therapy and predict rebleeding risk.
How does Rockall compare to Glasgow-Blatchford score?
Both are validated for UGIB risk stratification. Glasgow-Blatchford (GBS) may be better for predicting need for intervention and identifying very low-risk patients who can avoid endoscopy. Rockall is better for predicting mortality and includes endoscopic findings. Many centers use both.
What counts as "major comorbidity"?
Major comorbidities (2 points) include: ischemic heart disease, congestive heart failure, chronic lung disease, chronic kidney disease, stroke, or other significant organ dysfunction. Renal failure, liver failure, or metastatic cancer score 3 points due to higher mortality risk.
Should I stop anticoagulation in patients with UGIB?
Management depends on indication, bleeding severity, and risk. For life-threatening bleeding, hold anticoagulation and consider reversal agents. For less severe bleeding, may continue if high thrombotic risk. Restart when hemostasis achieved and bleeding risk acceptable. Consult hematology/cardiology for complex cases.
When should I order urgent vs routine endoscopy?
Urgent endoscopy (within 12 hours) for: hemodynamic instability despite resuscitation, suspected variceal bleeding, or high-risk features. Most other patients can undergo endoscopy within 24 hours after resuscitation and stabilization. Earlier endoscopy (within 12-24 hours) may reduce transfusions and hospital stay.
Related Calculators
MELD Score Calculator
Calculate liver transplant priority and mortality risk
Child-Pugh Score Calculator
Assess cirrhosis severity and prognosis
Maddrey Discriminant Function
Evaluate alcoholic hepatitis severity
Lille Score Calculator
Assess steroid response in alcoholic hepatitis
Hepatic Encephalopathy Grade
Grade hepatic encephalopathy severity
BUN/Creatinine Ratio Calculator
Helps distinguish upper vs lower GI bleeding