Rockall score (pre-endoscopy)
Clinical Rockall score at presentation in upper GI bleeding, before endoscopy
Sources last checked: 2026-10-13
Rockall score (pre-endoscopy)
Clinical Rockall score at presentation in upper GI bleeding, before endoscopy
Derived to predict mortality, not the need for intervention. For deciding on outpatient management the Glasgow-Blatchford score performs better.
Interpretation
| 0 — low risk | The low-risk group at presentation in Rockall's derivation cohort (about 15 % of all bleeds). |
|---|---|
| ≥ 1 — not low risk | Cannot be classed as low risk before endoscopy; the complete Rockall score is defined after endoscopy. ESGE prefers the Glasgow-Blatchford score for pre-endoscopy triage. |
What is the Rockall score (pre-endoscopy)?
The pre-endoscopy (clinical) Rockall score uses age, shock and comorbidity to estimate mortality risk at presentation with upper gastrointestinal bleeding. It is the first part of the score Rockall and colleagues derived in 1996 from a UK national audit of more than 4,000 bleeds. After endoscopy, diagnosis and stigmata are added to give the complete score.
When to use it
- Upper GI bleeding at presentation, as an early mortality estimate
- Teaching or audit when the complete Rockall score will follow endoscopy
- Comparing with the Glasgow-Blatchford score in local protocols
When not to use it
- Deciding on outpatient management — ESGE recommends the Glasgow-Blatchford score for this
- Lower GI bleeding
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 |
Clinical pearls and limitations
- Derived to predict mortality, not the need for intervention. For deciding on outpatient management the Glasgow-Blatchford score performs better.
- Maximum pre-endoscopy score is 7 (age 2 + shock 2 + comorbidity 3).
- Comorbidity carries the most weight: renal failure, liver failure or disseminated cancer scores 3.
- A score of 0 identified the low-risk group at presentation in Rockall's cohort.
Frequently asked questions
What is the difference between the pre-endoscopy and the complete Rockall score?
The pre-endoscopy score uses only age, shock and comorbidity (0–7). The complete score adds the endoscopic diagnosis and stigmata of recent haemorrhage (0–11).
Which score does ESGE recommend before endoscopy?
ESGE 2021 recommends the Glasgow-Blatchford score for pre-endoscopy risk stratification, with GBS ≤ 1 defining very-low-risk patients.
How is shock defined in the Rockall score?
Tachycardia is a pulse of 100/min or more with systolic BP ≥ 100 mmHg (1 point); hypotension is systolic BP below 100 mmHg (2 points).
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.
- Gralnek IM et al. ESGE Guideline – Update 2021 (NVUGIH). Endoscopy 2021;53:300-332 — compares GBS, pre-endoscopy Rockall and AIMS65; recommends GBS for pre-endoscopy stratification.
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