Rockall score

Rockall score is a clinical prediction rule that was initially developed to predict the risk of rebleeding in patients who have had a gastrointestinal bleed. It has since been validated as a tool to predict mortality in these patients as well. The score is calculated based on clinical criteria and endoscopic findings.

Clinical Criteria

The clinical criteria used in the Rockall score include age, shock, and comorbidity. Each of these factors is assigned a score, with higher scores indicating a higher risk of rebleeding or death.

• Age: Patients under the age of 60 are assigned a score of 0, those between 60 and 79 are assigned a score of 1, and those 80 and older are assigned a score of 2.
• Shock: The presence of shock is assessed based on the patient's heart rate and systolic blood pressure. Patients with a heart rate under 100 and a systolic blood pressure over 100 are assigned a score of 0, those with a heart rate over 100 or a systolic blood pressure between 100 and 89 are assigned a score of 1, and those with a systolic blood pressure under 90 are assigned a score of 2.
• Comorbidity: The presence of comorbidities is also considered. Patients with no major comorbidity are assigned a score of 0, those with heart failure, ischemic heart disease, or any major comorbidity are assigned a score of 2, and those with renal failure, liver failure, or disseminated malignancy are assigned a score of 3.

Endoscopic Findings

The endoscopic findings used in the Rockall score include the diagnosis and the presence of major stigmata of recent hemorrhage. Each of these factors is assigned a score, with higher scores indicating a higher risk of rebleeding or death.

• Diagnosis: The diagnosis is based on the findings of the endoscopy. Patients with no lesion or with Mallory-Weiss tear are assigned a score of 0, those with all other diagnoses are assigned a score of 1, and those with malignancy are assigned a score of 2.
• Major Stigmata of Recent Hemorrhage: The presence of major stigmata of recent hemorrhage is also considered. Patients with none are assigned a score of 0, and those with blood in the upper gastrointestinal tract, adherent clot, visible or spurting vessel are assigned a score of 2.

Interpretation

The total Rockall score ranges from 0 to 11, with higher scores indicating a higher risk of rebleeding or death. A score of 0 indicates a very low risk, while a score of 11 indicates a very high risk.

See Also

• Gastrointestinal bleeding
• Clinical prediction rule
• Endoscopy