Rockall Score for Upper GI Bleeding (Pre-Endoscopy)
Clinical (pre-endoscopy) Rockall Score using only clinical variables available at admission, before endoscopy. Predicts mortality and re-bleeding in upper GI haemorrhage. The Glasgow-Blatchford score is more accurate for triage; pre-endoscopy Rockall identifies very high-risk patients.
Score interpretation
Lower risk of in-hospital mortality -- semi-urgent endoscopy acceptable
→ Endoscopy within 24 hours (or next available list); GBS score for triage of outpatient management suitability (GBS 0 = very low risk, consider outpatient management); resuscitation: IV access, FBC, U+E, LFTs, coagulation, group and save; do not start a PPI before endoscopy (NICE CG141) — give it after endoscopic treatment of non-variceal bleeding; correct coagulopathy if present (FFP, platelets, vitamin K); restrict transfusion: Hb target 70-80 g/L (TRIGGER trial -- restrictive superior); NBM or clear fluids; document GBS score alongside Rockall.
Moderate mortality risk -- urgent endoscopy and inpatient monitoring required
→ Urgent endoscopy within 12-24 hours (after haemodynamic stabilisation); inpatient admission mandatory; fluid resuscitation: 2 large-bore IV cannulae, 0.9% saline cautiously (1000 mL over 1 hour if SBP < 100); PPI after endoscopic haemostasis, not before endoscopy (NICE CG141); cross-match 2-4 units; HDU level if haemodynamically unstable; withhold anticoagulants (warfarin: vitamin K + PCC; DOACs: reversal agents if available and bleeding life-threatening); NGT only if clinically indicated; senior endoscopist for haemostatic therapy.
High mortality risk -- emergency endoscopy and HDU/ITU involvement essential
→ Emergency endoscopy within 12 hours after haemodynamic stabilisation; ICU/HDU admission; massive haemorrhage protocol if haemodynamic compromise: major haemorrhage protocol activation, O-negative blood if needed, MHP ratio 1:1:1 (pRBC:FFP:platelets); erythromycin (adults: 250 mg IV) 30-120 min before endoscopy (gastric emptying -- improves visualisation; ESGE); terlipressin and prophylactic antibiotics at presentation if variceal bleeding is suspected (NICE CG141); endoscopic haemostasis (adrenaline injection + mechanical clips for PUD; banding or TIPS for variceal bleeding); interventional radiology (transcatheter arterial embolisation) if endoscopic failure; surgical referral if all else fails; somatostatin analogue (octreotide) for variceal bleeding. Children: use a children's formulary.
Interpretation bands for the Rockall Pre-Endoscopy. Apply clinical judgement and local guidance.
References
- Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316–321.
- NICE CG141. Acute upper gastrointestinal bleeding in over 16s: management. 2012.
Related
Curated clinical cross-links plus same-class fallbacks.
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Terlipressin · Gastrointestinal Emergency
Featured in these MRCEM clinical pathways
The Rockall Pre-Endoscopy is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.