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    Patent Pending

    Rockall Score for Upper GI Bleeding (Pre-Endoscopy)

    Determines severity of GI bleeding, prior to endoscopy.
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    INSTRUCTIONS

    Use this score for upper GI bleed patients who have NOT yet had endoscopy. Use the Complete Rockall Score for patients who have had endoscopy.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with clinical upper GI bleeding, prior to endoscopy.

    • The pre-endoscopy Rockall Score estimates mortality in patients with active upper GI bleed who have not had endoscopy.
    • It 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 pre-endoscopy score is calculated based on clinical bleeding (i.e., without 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 pre-endoscopy 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

    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.
    • Note: The pre-endoscopy Rockall Score has not been shown to clearly identify individual patients who require intervention.

    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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