Rockall score (complete, post-endoscopy)
Mortality and rebleeding risk after endoscopy in upper GI bleeding
Sources last checked: 2026-10-13
Rockall score (complete, post-endoscopy)
Mortality and rebleeding risk after endoscopy in upper GI bleeding
Predicts death better than rebleeding. Bands summarise the 1996 derivation cohort; absolute risks in today's practice are lower.
Interpretation
| 0–2 — low risk | In the derivation cohort mortality was close to zero and rebleeding under 5 %; Rockall et al. described this group as a candidate for early discharge. |
|---|---|
| 3–7 — intermediate risk | Mortality rises steadily with each point. |
| ≥ 8 — high risk | Very high-risk category in Rockall's series; high mortality. |
What is the Rockall score (complete, post-endoscopy)?
The complete Rockall score combines age, shock and comorbidity with the endoscopic diagnosis and stigmata of recent haemorrhage to estimate mortality and rebleeding after upper gastrointestinal bleeding. It was derived by Rockall, Logan, Devlin and Northfield (Gut 1996) from a UK multicentre audit and validated in the Netherlands in 1999.
When to use it
- After endoscopy for upper GI bleeding, to estimate mortality risk
- Supporting early discharge decisions in patients with low scores after endoscopy
- Audit and benchmarking of upper GI bleeding outcomes
When not to use it
- Before endoscopy — use the Glasgow-Blatchford or pre-endoscopy Rockall score
- Predicting rebleeding alone — discrimination for rebleeding is modest
How it is calculated
| Criterion | Points |
|---|---|
| Age | |
| < 60 years | 0 |
| 60–79 years | 1 |
| ≥ 80 years | 2 |
| Shock | |
| No shock (systolic BP ≥ 100 mmHg, pulse < 100 /min) | 0 |
| Tachycardia (pulse ≥ 100 /min, systolic BP ≥ 100 mmHg) | 1 |
| Hypotension (systolic BP < 100 mmHg) | 2 |
| Comorbidity | |
| No major comorbidity | 0 |
| Cardiac failure, ischaemic heart disease or other major comorbidity | 2 |
| Renal failure, liver failure or disseminated malignancy | 3 |
| Endoscopic diagnosis | |
| Mallory-Weiss tear, or no lesion and no stigmata | 0 |
| All other diagnoses | 1 |
| Malignancy of the upper GI tract | 2 |
| Major stigmata of recent haemorrhage | |
| None, or dark spot only | 0 |
| Blood in upper GI tract, adherent clot, visible or spurting vessel | 2 |
Clinical pearls and limitations
- Predicts death better than rebleeding. Bands summarise the 1996 derivation cohort; absolute risks in today's practice are lower.
- Score 0–2: mortality close to zero and rebleeding under 5 % in the derivation cohort.
- Score ≥ 8 was the very-high-risk category.
- Major stigmata (adherent clot, visible or spurting vessel, blood in the upper GI tract) add 2 points; a flat dark spot scores 0.
- The score predates modern endoscopic therapy and PPIs; absolute risks are now lower.
Frequently asked questions
What is a high Rockall score?
In the original series, 8 or more was the very-high-risk group; 0–2 was low risk with near-zero mortality.
What is the maximum Rockall score?
11 points for the complete score; 7 for the pre-endoscopy score.
Does a Mallory-Weiss tear score points?
No — a Mallory-Weiss tear, or no lesion and no stigmata, scores 0 for diagnosis. Upper GI malignancy scores 2, all other diagnoses 1.
Evidence and guidelines
- Primary source: Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38(3):316-321.
- Vreeburg EM et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 1999;44(3):331-335.
- Gralnek IM et al. ESGE Guideline – Update 2021 (NVUGIH). Endoscopy 2021;53:300-332.
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