Rockall Score Calculator

Calculate the Rockall Score for upper gastrointestinal bleeding to predict mortality and rebleeding risk. Includes both pre-endoscopy (clinical) and full (post-endoscopy) scoring options.

Important Clinical Disclaimer: The Rockall Score Calculator is intended for use by qualified healthcare professionals only. It is for educational and informational purposes and should not replace clinical judgement. Always interpret results alongside the full clinical picture and follow your local guidelines and protocols.
Rockall Score Parameters
Clinical (Pre-Endoscopy) Variables
IHD = ischaemic heart disease
Endoscopic Variables (Optional)

Complete these fields after endoscopy for full Rockall Score

About Rockall Score

The Rockall Score was developed from the UK National Audit of Acute Upper GI Haemorrhage (1995) involving 4,185 patients.

Two versions:

  • Pre-endoscopy (Clinical): Uses age, shock, and comorbidities only (max 7 points)
  • Full Rockall: Adds endoscopic diagnosis and stigmata (max 11 points)
Unlike Glasgow-Blatchford (which predicts intervention need), Rockall primarily predicts mortality and rebleeding.
Pre-Endoscopy (Clinical) Scoring
Variable Score 0 Score 1 Score 2 Score 3
Age <60 60-79 ≥80 -
Shock None Tachycardia Hypotension -
Comorbidity None - CHF, IHD, other Renal/liver failure, malignancy
Maximum pre-endoscopy score: 7
Endoscopic Variables
Variable Score 0 Score 1 Score 2
Diagnosis Mallory-Weiss, no lesion, no SRH All other diagnoses Upper GI malignancy
SRH None or dark spot - Blood, clot, visible vessel
SRH = Stigmata of Recent Haemorrhage
Full Rockall Score Mortality
Score Mortality Rebleeding
0 0% 5%
1 0% 3%
2 0.2% 5%
3 2.9% 11%
4 5.3% 14%
5 10.8% 24%
6 17.3% 33%
7 27% 44%
≥8 41% 42%

Rockall vs Glasgow-Blatchford: When to Use Each

Glasgow-Blatchford Score (GBS)

Best for: Initial triage at presentation

  • Predicts need for intervention
  • Identifies low-risk patients (GBS 0)
  • Helps decide admission vs outpatient
  • Does NOT require endoscopy

Use when:

  • Initial ED assessment
  • Deciding on admission
  • Pre-endoscopy risk stratification
Rockall Score

Best for: Prognostication

  • Predicts mortality
  • Predicts rebleeding risk
  • Full score requires endoscopy
  • Better for outcome prediction

Use when:

  • After endoscopy (full score)
  • Communicating prognosis
  • Planning level of care
  • Audit and outcome reporting

Forrest Classification of Ulcer Bleeding

The Forrest classification describes stigmata of recent haemorrhage (SRH) at endoscopy and correlates with rebleeding risk:

Forrest Class Description Rebleed Risk Rockall SRH Points
Ia Spurting haemorrhage ~90% 2
Ib Oozing haemorrhage ~50% 2
IIa Non-bleeding visible vessel ~40% 2
IIb Adherent clot ~20% 2
IIc Flat pigmented spot ~10% 0
III Clean base ulcer ~5% 0

Frequently Asked Questions

A full Rockall Score of 0 (after endoscopy) indicates excellent prognosis with 0% mortality and ~5% rebleeding risk. These patients can generally be discharged with:

  • PPI therapy
  • Clear safety-netting advice
  • Appropriate follow-up arranged

Important: A pre-endoscopy Rockall of 0 does not have the same low-risk implications. The pre-endoscopy score is less accurate for identifying truly low-risk patients compared to Glasgow-Blatchford Score.

For pre-endoscopy triage, Glasgow-Blatchford Score 0 is the recommended criterion for considering outpatient management.

2 points:

  • Cardiac failure
  • Ischaemic heart disease (IHD)
  • Any other major comorbidity (e.g., COPD, diabetes, other significant conditions)

3 points:

  • Renal failure (significant CKD or AKI)
  • Liver failure (decompensated cirrhosis, acute liver failure)
  • Disseminated malignancy (metastatic cancer)

These conditions score higher because they significantly impact mortality in GI bleeding and may limit treatment options.

The pre-endoscopy Rockall Score has limited accuracy for identifying low-risk patients:

  • A pre-endoscopy score of 0 does not reliably identify low-risk patients
  • Many patients with pre-endoscopy score 0 may still need intervention
  • It was originally designed alongside the endoscopic component

For pre-endoscopy risk stratification, Glasgow-Blatchford Score is superior because:

  • GBS 0 has <1% need for intervention (excellent sensitivity)
  • NICE recommends GBS for identifying patients suitable for outpatient management
  • Better validated for this specific purpose

Use pre-endoscopy Rockall for initial prognostication, but rely on GBS for triage decisions.

Variceal bleeding is classified under "all other diagnoses" (1 point) in the Rockall Score. However:

  • Variceal bleeding has higher mortality (~20-30%) than typical non-variceal bleeding
  • Patients with cirrhosis already score 3 points for liver failure comorbidity
  • Active variceal bleeding scores 2 additional points for SRH

For variceal bleeding specifically:

  • Use Child-Pugh Score for liver-specific prognostication
  • Consider specialist hepatology/gastroenterology scoring systems
  • Follow BSG guidelines for variceal haemorrhage management

High Rockall scores indicate significant rebleeding risk. However:

  • Routine second-look endoscopy is NOT recommended by NICE or international guidelines
  • Repeat endoscopy is indicated if there is clinical evidence of rebleeding:
    • Fresh haematemesis or melaena
    • Haemodynamic instability
    • Falling haemoglobin despite transfusion
  • High-risk stigmata (Forrest Ia/Ib/IIa) should receive endoscopic therapy at index endoscopy

For patients with persistent bleeding despite endoscopic therapy, consider interventional radiology (embolisation) or surgery.

Disclaimer

This calculator is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

  • Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.
  • Never disregard professional medical advice or delay seeking it because of information from this tool.
  • Clinical decision-making should always incorporate the full clinical context, patient preferences, and local protocols.
  • The creators of this tool accept no liability for decisions made based on its output.

If you are a patient: please discuss any results with your healthcare provider. This tool is designed for use by medical professionals and may not be appropriate for self-assessment.

References

  1. Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-321. doi:10.1136/gut.38.3.316
  2. Rockall TA, et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. BMJ. 1995;311(6999):222-226.
  3. NICE. Acute upper gastrointestinal bleeding in over 16s: management (NG141). 2016 (updated 2019). https://www.nice.org.uk/guidance/ng141
  4. Forrest JA, et al. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877):394-397.
  5. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019;364:l536. doi:10.1136/bmj.l536
  6. Gralnek IM, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1-a46.