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    Rockall Score for Upper GI Bleeding (Complete)

    Determines severity of GI bleeding.
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    INSTRUCTIONS

    Use this score for known upper GI bleed patients with a completed endoscopy. Use the Pre-Endoscopy Rockall Score for patients who have not yet had endoscopy.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with clinical upper GI bleeding who have undergone endoscopy.

    • The complete Rockall Score estimates mortality in patients with active upper GI bleed who have had endoscopy.
    • Use the pre-endoscopy Rockall Score for patients with upper GI bleed who have not undergone endoscopy.
    • The Rockall Score is supported by multiple validation studies, most showing moderate prediction of death at higher risk.
    • It can predict very low risk patients, but with less accuracy.
    • The complete Rockall Score is calculated based on clinical bleeding AND endoscopy results.
    • Upper GI bleeding may present in different degrees of severity, from minor bleeding that can be managed outpatient to severe, life-threatening hemorrhage.
    • The complete Rockall Score can help stratify which patients need endoscopy and intensive care. It is less accurate at identifying low-risk patients (e.g. those who may be treated as outpatients).
    <60 years
    0
    60-79 years
    +1
    ≥80 years
    +2
    No shock (SBP ≥100 AND HR <100)
    0
    Tachycardia (SBP ≥100 AND HR ≥100)
    +1
    Hypotension (SBP <100)
    +2
    No major comorbidity
    0
    Any comorbidity EXCEPT renal failure, liver failure, and/or disseminated malignancy
    +2
    Renal failure, liver failure, and/or disseminated malignancy
    +3
    Mallory-Weiss tear
    0
    No lesion identified and no stigmata of recent hemorrhage
    0
    All other diagnoses
    +1
    Malignancy of upper GI tract
    +2
    None
    0
    Dark spot only
    0
    Blood in upper GI tract
    +2
    Adherent clot
    +2
    Visible or spurting vessel
    +2

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • The Rockall score predicts mortality better than does chance alone, but overall should be interpreted with caution—a score of ‘0’ in some studies suggested very low mortality, but in others was not a consistent indicator.
    • Other scores such as the Glasgow-Blatchford Score may perform better, particularly for identifying very low risk patients. According to the American College of Gastroenterology’s management guidelines for patients with overt upper GI bleeding, neither the Rockall nor Glasgow-Blatchford Scores can reliably predict which individual patients will need an intervention, except for patients with a Glasgow-Blatchford Score of 0 (< 1% chance of requiring intervention).

    Management

    • Consider diagnostic endoscopy for patients with high risk of mortality from upper GI bleeding.
    • Consider ICU level of care for patients who are hemodynamically unstable from upper GI bleeding.

    Critical Actions

    Patients with a high mortality or risk of rebleeding should be considered for intervention and/or monitoring.

    Content Contributors
    About the Creator
    Dr. Timothy Rockall
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