Unifying Concepts

The Rockall Scoring System

The Rockall score is an established and useful system to assess upper gastrointestinal bleeding (UGIB). The Rockall system has been shown to represent an accurate and valid predictor of rebleeding and death, performing better in the latter than in the former. Rockall scores are designed to combine information such as the subject’s age, occurrence of shock assessed from systolic blood pressure readings and pulse rate, presence and severity of comorbid conditions, diagnosis and endoscopic stigmata of recent bleeding.

Summing up the different levels of a point grading system assigned to each of the components yields a subject’s risk score bounded on a scale of 0 to 11, with 11 representing the highest risk. Results of previous investigations and validations of the scoring system have highlighted that those with a score of </= 2 are associated with a very low rate of bleeding recurrences and death and, therefore, can be reasonably managed as outpatients.

The Rockall scoring system

Variable 0 1 2 3
Age, y < 60 60–79 >/= 80
Shock No shock
Systolic BP > 100 mm Hg
Pulse <  100 beats/min
Systolic BP > 100 mm Hg
Pulse > 100 beats/min
Systolic BP <  100 mm Hg
Comorbidity Nil major Cardiac failure, ischemic heart disease, any major comorbidity Renal failure, liver failure, disseminated malignancy
Diagnosis Mallory–Weiss tear, no lesion, and no SRH All other diagnoses Malignancy of upper-GI tract
Major SRH None, or dark spot Blood in upper-GI tract, adherent clot, visible or spurting vessel

BP, blood pressure; SRH, stigmata of recent hemorrhage.



  1. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996 Mar;38(3):316-21. [Medline]
  2. Tham TC, James C, Kelly M. Predicting outcome of acute non-variceal upper gastrointestinal haemorrhage without endoscopy using the clinical Rockall Score. Postgrad Med J. 2006 Nov;82(973):757-9. [Medline]
  3. Sanders DS, Perry MJ, Jones SG, McFarlane E, Johnson AG, Gleeson DC, Lobo AJ. Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation. Eur J Gastroenterol Hepatol. 2004 May;16(5):487-94. [Medline]


Created Jul 8, 2011.

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