MAGENT

Pre-endoscopy Rockall score: how age, shock and comorbidity are scored

The pre-endoscopy Rockall score adds three parts after acute upper gastrointestinal bleeding: age (0 to 2), shock (0 to 2) and comorbidity (0, 2 or 3). The total runs from 0 to 7.

Not a medical device. Not a diagnosis or dosing recommendation.

Use this calculator via API

What is the pre-endoscopy Rockall score?

The Rockall score comes from T. A. Rockall, R. F. Logan, H. B. Devlin and T. C. Northfield, who described it in Gut in 1996. The full (complete) score also uses findings from endoscopy. The pre-endoscopy score, also called the admission or clinical Rockall score, is the part of the same score that can be worked out before endoscopy: age, shock and comorbidity.

Magent's calculator is the pre-endoscopy score. It isn't the complete Rockall score, AIMS65 or the Glasgow-Blatchford score.

This page explains the arithmetic. The calculator returns the total out of 7. This page doesn't say what a total means for a particular person.

The pre-endoscopy Rockall formula

Rockall (pre-endoscopy) = Age:  under 60 → 0, 60–79 → 1, 80 or older → 2
                        + Shock: systolic BP under 100 → 2
                                 otherwise heart rate 100 or more → 1
                                 otherwise → 0
                        + Comorbidity: none → 0, cardiac → 2,
                                       renal, liver or metastatic → 3
maximum = 7

Exact expression the calculator uses:

pre-endoscopy Rockall = age (<60: 0, 60-79: 1, >=80: 2) + shock (SBP<100: 2; else HR>=100: 1; else 0) + comorbidity (none: 0, cardiac: 2, renal_liver_metastatic: 3); max 7

What each part means

InputWhat you enterPoints
ageAge in years, 18 to 120Under 60: 0. 60 to 79: 1. 80 or older: 2
systolic_mm_hgSystolic blood pressure in mm Hg, 50 to 250Under 100: 2 (hypotension)
heart_rate_bpmHeart rate in beats per minute, 30 to 220100 or more: 1 (tachycardia), counted when systolic BP is 100 or more
comorbiditynone, cardiac or renal_liver_metastatic0, 2 or 3

How the score works

  1. Score age. Under 60 is 0, 60 to 79 is 1, and 80 or older is 2.
  2. Score shock. Check systolic blood pressure first. Under 100 scores 2, and the heart rate isn't added. If it's 100 or more, a heart rate of 100 or more scores 1. Otherwise shock is 0.
  3. Score comorbidity. none is 0. cardiac (cardiac failure, ischaemic heart disease or any major comorbidity) is 2. renal_liver_metastatic (renal failure, liver failure or disseminated malignancy) is 3.
  4. Add the three parts. The total is 0 to 7.

Inputs come from the user

The calculator scores age, heart rate and blood pressure from the numbers you enter. Comorbidity is a category you choose; Magent's calculator doesn't assign it. Endoscopic findings aren't inputs.

Worked examples

These use Magent's own expected values for the calculator. Each line adds age, shock and comorbidity in that order.

Example 1: age 50, heart rate 80, systolic 120, no comorbidity

  1. Age 50 is under 60 → 0. Systolic 120 and heart rate 80 → 0. Comorbidity none → 0.
  2. Score: 0 + 0 + 0 = 0 out of 7.

Example 2: Example 1 at age 60

  1. Age 60 is in 60 to 79 → 1.
  2. Score: 1 + 0 + 0 = 1 out of 7.

Example 3: Example 1 at age 80

  1. Age 80 is 80 or older → 2.
  2. Score: 2 + 0 + 0 = 2 out of 7.

Example 4: age 50, heart rate 100, systolic 100, no comorbidity

  1. Systolic 100 isn't under 100, so check heart rate. Heart rate 100 → 1.
  2. Score: 0 + 1 + 0 = 1 out of 7.

Example 5: age 50, heart rate 60, systolic 99, no comorbidity

  1. Systolic 99 is under 100 → 2.
  2. Score: 0 + 2 + 0 = 2 out of 7.

Example 6: Example 1 with renal, liver or metastatic comorbidity

  1. renal_liver_metastatic → 3.
  2. Score: 0 + 0 + 3 = 3 out of 7.

Example 7: age 80, heart rate 60, systolic 99, renal, liver or metastatic comorbidity

  1. Age 80 → 2. Systolic 99 → 2. Comorbidity → 3.
  2. Score: 2 + 2 + 3 = 7 out of 7, the maximum.

Values at the boundaries

All are Magent's expected values or the calculator's stated boundaries.

  • Age 59 → 0; age 60 → 1; age 79 → 1; age 80 → 2.
  • Heart rate 99 with systolic 100 → 0; heart rate 100 with systolic 100 → 1.
  • Systolic 99 → 2, whatever the heart rate; systolic 100 → no hypotension points.
  • Comorbidity cardiac → 2.

History of the Rockall score

The score comes from Rockall TA, Logan RF, Devlin HB and Northfield TC, Risk assessment after acute upper gastrointestinal haemorrhage, Gut, 1996 (volume 38, issue 3, pages 316–321). The abstract describes a prospective, unselected, multicentre, population-based study. Age, shock, comorbidity, findings at endoscopy and rebleeding were each independent predictors of mortality, and a numerical score was built from them.

Vreeburg and colleagues tested the Rockall scoring system in upper gastrointestinal bleeding in Gut in 1999.

Stanley and colleagues compared risk scoring systems for upper gastrointestinal bleeding in an international multicentre prospective study in the BMJ in 2017.

When it's used

The 1996 paper studied people with acute upper gastrointestinal haemorrhage. The pre-endoscopy score uses the parts known before endoscopy. Guidelines from the International Consensus Group in 2019 and the American College of Gastroenterology in 2021 are listed under Further reading.

Where it's used

The inputs are age, a heart rate, a systolic blood pressure and the person's other conditions, all available at presentation.

Who uses it

The person using the calculator chooses the comorbidity category. The calculator scores age and shock and adds the points.

Limits of the calculation

  • It adds up three parts. It doesn't identify the cause of bleeding or how severe it is.
  • It's the pre-endoscopy score. The complete Rockall score adds endoscopic findings, which aren't inputs here.
  • It isn't AIMS65 or the Glasgow-Blatchford score.
  • Comorbidity is a category you choose; the calculator doesn't assign it.
  • This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

  • Glasgow-Blatchford score is a separate upper GI bleeding score built from blood urea, haemoglobin, systolic blood pressure and heart rate, plus four clinical findings (melaena, syncope, hepatic disease and cardiac failure).
  • Complete Rockall score adds endoscopic findings to the three parts on this page.

Glossary

  • Upper gastrointestinal bleeding: bleeding from the oesophagus, stomach or duodenum.
  • Endoscopy: a look inside the gut with a camera on a flexible tube.
  • Systolic blood pressure: the top number in a blood pressure reading.
  • Tachycardia: a fast heart rate.
  • Hypotension: low blood pressure.
  • Disseminated malignancy: cancer that has spread.

Common mistakes

  • Adding tachycardia to hypotension. When systolic is under 100, shock scores 2 and heart rate isn't added.
  • Scoring systolic 100 as hypotension. Hypotension is under 100.
  • Giving cardiac comorbidity 1 point. It's 2; renal, liver or metastatic is 3.
  • Using the complete score's top. The pre-endoscopy score tops out at 7.

Source

Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316-321. DOI: 10.1136/gut.38.3.316. PMID: 8675081

Further reading

  1. Vreeburg EM, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999;44(3):331-335. PMID: 10026316
  2. Stanley AJ, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. PMID: 28053181
  3. Barkun AN, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171(11):805-822. PMID: 31634917
  4. Laine L, et al. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917. PMID: 33929377

Frequently asked questions

How do you calculate the pre-endoscopy Rockall score?

Score age (0 to 2), shock (0 to 2) and comorbidity (0, 2 or 3), then add them. The total is 0 to 7.

What is the difference between the pre-endoscopy and complete Rockall score?

The pre-endoscopy score uses age, shock and comorbidity. The complete score, from the same 1996 paper, also uses findings from endoscopy.

What is the highest pre-endoscopy Rockall score?

7: age 80 or older (2), systolic under 100 (2), and renal, liver or metastatic comorbidity (3).

Does a fast heart rate add points if blood pressure is low?

No. When systolic is under 100, shock scores 2 and heart rate isn't added.

Is this the same as the Glasgow-Blatchford score?

No. They're separate scores with different inputs.