Risk after an upper GI bleed
Bleeding from the esophagus, stomach or duodenum, usually from a peptic ulcer, sends many people to hospital each year. Most stop bleeding on their own, but some rebleed or die, often because of other illnesses. The Rockall score, published by Tim Rockall and colleagues in 1996 from a large UK audit, estimates that risk.
The components
| Variable | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| Age | under 60 | 60–79 | 80 or older | |
| Shock | none | pulse 100 or more | systolic below 100 mmHg | |
| Comorbidity | none major | heart failure, ischemic heart disease, other major | kidney or liver failure, disseminated cancer | |
| Diagnosis | Mallory-Weiss tear, or no lesion | all other diagnoses | upper GI cancer | |
| Stigmata of recent bleeding | none or dark spot | blood, adherent clot, visible or spurting vessel |
The clinical (pre-endoscopy) score uses the first three rows, from 0 to 7. The complete score adds the two endoscopic findings, from 0 to 11.
Interpreting the complete score
- 0 to 2: low risk. Mortality was below 1% in the original study, and rebleeding was uncommon. Such patients may be suitable for early discharge.
- 3 to 4: intermediate risk.
- 5 or more: high risk, with mortality above 10% in the original study, rising further with each point.
Worked example
A 68-year-old (1 point) with a normal pulse and blood pressure and no major illnesses has a duodenal ulcer at endoscopy (1 point) with a clean base and no stigmata (0 points). The clinical score is 1 and the complete score 2: low risk.
Rockall and Glasgow-Blatchford
The two scores answer different questions:
- The Glasgow-Blatchford score uses blood tests and vital signs before endoscopy to identify patients who will need a transfusion, endoscopic treatment or surgery. A score of 0 or 1 allows outpatient management.
- The complete Rockall score uses endoscopy findings and is better at predicting death.
Guidelines from the UK, Europe and the US recommend Glasgow-Blatchford for pre-endoscopy triage; the complete Rockall remains useful after endoscopy.
Limits
The score was built on patients from the early 1990s, before modern acid suppression and endoscopic techniques, so absolute risks are lower today. It was not designed for lower GI bleeding or variceal bleeding in cirrhosis, where other scores apply.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.