Rockall Score

Another risk assessment tool is the Rockall score (table 1). Rockall et al (1996) 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 (table 2). [10]

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 Glasgow-Blatchford Score can be used in conjunction with clinical assessment to identify low-risk patients who may be suitable for discharge from the emergency department to attend outpatient follow-up.

Table 1. Calculating the Rockall Score