Rockall Score Calculator
Rockall Score Calculator
Rockall’s risk score for acute upper gastrointestinal haemorrhage, with the pre-endoscopy subtotal beside the full score. Comorbidity scores 0, 2 or 3 and stigmata 0 or 2 — neither item has a 1-point option.
Rockall score
5 items → 0–11Age 60 to 79, tachycardia with systolic 100 or more, no major comorbidity, peptic ulcer at endoscopy, visible vessel — full score
Scoring
Full Rockall = initial + diagnosis (0–2) + major stigmata of recent haemorrhage (0 or 2) → maximum 11
- two items have no 1-point option
- comorbidity scores 0, 2 or 3; major stigmata 0 or 2. The commonest reimplementation error, and detectable from the maxima alone: a version that tops out at 6 before endoscopy and 10 after has flattened these two items. The right answers are 7 and 11
- 3 is the only 3
- renal failure, liver failure or disseminated malignancy is the single 3-point option in the whole instrument. Every other item tops out at 2
- two scores, two tables
- mortality by initial score in 3,981 cases; rebleeding and mortality by complete score in 2,956. A pre-endoscopy 4 carried 24.6% mortality and a post-endoscopy 4 carried 5.3% — reading one against the other’s table is wrong by four or five fold
- shock, at exactly 100
- a systolic of 100 is not hypotension here. The bands are systolic ≥ 100 with pulse under 100 (0), systolic ≥ 100 with pulse ≥ 100 (1), systolic under 100 (2)
- derivation and vintage
- 4,185 cases in the 1993 UK national audit, with a 1,625-case validation audit in 1994 and an overall mortality of 14%. Bleeding mortality has fallen since, so the percentages are derivation performance, not a current prediction
Worked example
Age 60 to 79, tachycardia with systolic 100 or more, no major comorbidity, peptic ulcer at endoscopy, visible vessel — full score
Age 60–79 — 1 · tachycardia — 1 · no major comorbidity — 0
Initial (pre-endoscopy) subtotal 2
Peptic ulcer falls in all other diagnoses — 1 · visible vessel — 2 (not 1: this item has no 1-point option)
Full score 2 + 1 + 2 = 5 points
In Rockall's complete-score table a 5 carried 24.1% rebleeding and 10.8% total mortality in 453 cases
The initial subtotal of 2 carried 5.6% mortality in Table IV(A) — read against the complete-score table a 2 would look like 0.2%, a twenty-fold difference from reading the wrong table
Every item at its minimum gives 0; every item at its maximum — 80 or over, hypotension, renal or liver failure, upper GI malignancy, visible vessel — gives 2 + 2 + 3 + 2 + 2 = 11, with an initial subtotal of 7
Rockall’s numerical risk scoring system
| Variable | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| Age | Under 60 | 60 to 79 | 80 or over | — |
| Shock | No shock: systolic ≥ 100, pulse < 100 | Tachycardia: systolic ≥ 100, pulse ≥ 100 | Hypotension: systolic < 100 | — |
| Comorbidity | None major | — | Cardiac failure, ischaemic heart disease, any major comorbidity | Renal failure, liver failure, disseminated malignancy |
| Diagnosis | Mallory-Weiss tear, or no lesion and no stigmata | All other diagnoses | Upper gastrointestinal malignancy | — |
| Major stigmata of recent haemorrhage | None, or dark spot only | — | Blood in the upper GI tract, adherent clot, visible or spurting vessel | — |
Outcomes in Rockall’s own cohorts, by score
| Score | Initial score: mortality (n) | Full score: rebleeding | Full score: mortality (n) |
|---|---|---|---|
| 0 | 0.2% (595) | 4.9% | 0% (144) |
| 1 | 2.4% (505) | 3.4% | 0% (281) |
| 2 | 5.6% (641) | 5.3% | 0.2% (337) |
| 3 | 11.0% (890) | 11.2% | 2.9% (444) |
| 4 | 24.6% (859) | 14.1% | 5.3% (528) |
| 5 | 39.6% (326) | 24.1% | 10.8% (453) |
| 6 | 48.9% (141) | 32.9% | 17.3% (312) |
| 7 | 50.0% (24) | 43.8% | 27.0% (267) |
| 8 or more | not reachable | 41.8% | 41.1% (190) |
Two scores in one instrument, and two outcome tables
Rockall’s score came out of the first UK national audit of acute upper gastrointestinal haemorrhage — 4,185 cases in 1993, with a 1,625-case validation audit the following year — at a time when overall mortality was 14%. It was designed as a mortality score, not an intervention score, and that is the first thing that separates it from the Glasgow-Blatchford score, which was derived against the need for treatment.
The second thing is that it is really two instruments. The initial or pre-endoscopy score uses age, shock and comorbidity and runs from 0 to 7; the full score adds the endoscopic diagnosis and the major stigmata of recent haemorrhage and runs from 0 to 11. The paper reports separate outcome tables for each, and they differ sharply: an initial score of 4 carried 24.6% mortality while a full score of 4 carried 5.3%. The same number means something much worse when it has been reached on age, shock and comorbidity alone. Reading one score against the other’s table is the single most consequential mistake available here, and this page keeps both subtotals visible to make it harder.
Two items are routinely mis-scored. Comorbidity scores 0, 2 or 3 — there is no 1-point option — and major stigmata of recent haemorrhage score 0 or 2, again with nothing in between. The natural assumption that every item runs 0, 1, 2 flattens both and produces maxima of 6 and 10 instead of 7 and 11, understating every comorbid patient and every patient with endoscopic stigmata. The maxima are therefore a quick audit of any implementation, this one included. Also note that renal failure, liver failure or disseminated malignancy is the only 3-point option anywhere in the score.
Finally, the percentages are a 1990s UK cohort. Upper gastrointestinal bleeding mortality has fallen substantially since, so these figures are the score’s derivation performance rather than a contemporary prediction, and the ESGE 2021 guideline reports the pre-endoscopy Rockall score as highly sensitive and poorly specific — 0.93 and 0.24 for 30-day serious adverse events. A score is not a diagnosis and a risk derived from a cohort is not a probability for one patient. This states what the number predicted in a named study; the clinician in front of the patient decides what follows.
Frequently asked questions
What is the difference between the initial and the full Rockall score?
The initial or pre-endoscopy score uses age, shock and comorbidity and has a maximum of 7. The full score adds the endoscopic diagnosis and the major stigmata of recent haemorrhage, with a maximum of 11. Each has its own published outcome table, and they are not interchangeable: an initial 4 carried 24.6% mortality against 5.3% for a full 4.
Does comorbidity score 1 point in the Rockall score?
No. Comorbidity scores 0 for none, 2 for cardiac failure, ischaemic heart disease or any major comorbidity, and 3 for renal failure, liver failure or disseminated malignancy. There is no 1-point option, and the same is true of the stigmata item, which scores 0 or 2. That is why the maxima are 7 and 11.
What Rockall score counts as low risk?
In the original cohort a full score of 0 to 2 carried mortality of 0%, 0% and 0.2% in 762 cases. The ESGE 2021 guideline reports the pre-endoscopy Rockall score at a sensitivity of 0.93 and a specificity of 0.24 for 30-day serious adverse events. What a service does with a low score is a matter for its own pathway.
Which upper GI bleeding score should I use?
They answer different questions. The Glasgow-Blatchford score predicts the need for hospital-based intervention before endoscopy, AIMS65 predicts in-hospital mortality, and Rockall predicts mortality and — with the endoscopic items — rebleeding. Most guidelines use Glasgow-Blatchford at presentation.
Are the Rockall mortality figures still accurate?
Treat them as derivation performance, not a current estimate. They come from a UK national audit of 1993–94 in which overall mortality was 14%; management has changed and mortality has fallen. The ordering of the strata has held up in validation better than the absolute percentages.
Related calculators
References
- Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316–21.
- Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline — update 2021. Endoscopy. 2021;53(3):300–32.
- Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432 (as reported in the ESGE 2021 guideline).
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/