Rockall Score
Another risk assessment tool is the Rockall score. Rockall et al (1996)[ROCKALL] identified risk factors in 4185 patients with an upper GI haemorrhage. The score was validated on a further population of 625 patients and found to predict mortality but not the rate of re-bleeding (see Table 2).
The score consists of three clinical parameters (age, presence of shock, and comorbidity) and two parameters that rely on endoscopic findings (blood and diagnosis). The maximum pre-endoscopy Rockall score is 7 and post-endoscopy is 11. A Rockall score of 3 before endoscopy approximates with a 10% mortality rate and a score of 6, a 50% mortality rate.
The main disadvantage of the Rockall score is that it requires findings at endoscopy to calculate all the components of the score. However, the pre-endoscopy score can be used to help to identify those with high mortality that may benefit from critical care admission.
Learning Bite
Both the Glasgow-Blatchford and Rockall scores are useful tools to aid the clinician in identifying high-risk upper GI bleeds. The Blatchford Score can be used in conjunction with clinical assessment to identify low-risk patients who may be suitable for ED discharge.
|
Variable |
0 |
1 |
2 |
3 |
|
Age |
<60 |
60-79 |
>80 |
|
|
Shock |
‘none’ BP>100 P<100 |
‘tachycardia’ BP>100 P>100 |
‘hypotension’ BP<100 |
|
|
Comorbidity |
None |
Cardiac failure or IHD |
Renal failure, liver failure or disseminated malignancy |
|
|
Endoscopy |
No blood or dark spot only |
Blood in upper GI tract, adherent clot or spurting vessel |
||
|
Diagnosis |
Mallory-Weiss tear |
All other diagnoses |
GI tract malignancy |
Table 2. Mortality rates, by pre-endoscopy score
| Score | Mortality % |
| 0 | 0.2 |
| 1 | 2.4 |
| 2 | 5.6 |
| 3 | 11 |
| 4 | 24.6 |
| 5 | 39.6 |
| 6 | 48.9 |
| 7 | 50 |