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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

    Rockall Score for Upper GI Bleeding (Pre-Endoscopy)

    Determines severity of GI bleeding, prior to endoscopy.


    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
    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
    60-79 years
    ≥80 years
    No shock (SBP ≥100 AND HR <100)
    Tachycardia (SBP ≥100 AND HR ≥100)
    Hypotension (SBP <100)
    No major comorbidity
    Any comorbidity EXCEPT renal failure, liver failure, and/or disseminated malignancy
    Renal failure, liver failure, and/or disseminated malignancy


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    Creator Insights


    • 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).


    • 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.

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    Dr. Timothy Rockall
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