Rockall Score (Post-Endoscopy)
Predicts rebleeding and mortality after upper GI haemorrhage following endoscopy.
How to use & interpret
The Rockall score predicts the risk of rebleeding and mortality after an acute upper gastrointestinal bleed. The full (post-endoscopy) score combines clinical variables (age, shock, comorbidity) with endoscopic findings (diagnosis and stigmata of recent haemorrhage).
Lower scores indicate low risk and support earlier discharge; higher scores predict rebleeding and death and warrant closer monitoring. Use the Glasgow-Blatchford score at first presentation (pre-endoscopy) to identify very-low-risk patients.
Score interpretation
Rockall 0–2: low risk of rebleeding and negligible mortality after endoscopy (Rockall 1996).
→ Consider early discharge after successful haemostasis (score 0–1). PPI therapy. Outpatient follow-up.
Rockall 3–4: intermediate risk; mortality and rebleeding rise with each point.
→ Inpatient management. IV PPI infusion post-endoscopy if high-risk stigmata treated.
Rockall 5 or more: high risk of death and rebleeding; risk is highest at 8 or more.
→ HDU/ICU admission. Repeat endoscopy if rebleed. Early surgical/IR review.
Interpretation bands for the Rockall. Apply clinical judgement and local guidance.
Frequently asked questions
When is the Rockall score calculated?
The complete Rockall score requires endoscopic findings, so it is calculated after endoscopy; a pre-endoscopy (clinical) Rockall exists but the Glasgow-Blatchford score is preferred for initial triage.
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.
- Lisinopril (HFrEF / Post-MI) · ACE Inhibitor / HFrEF
- Colchicine (Pericarditis / Post-MI Inflammation) · Pericarditis / Coronary Inflammation
- Clopidogrel (ACS / Post-PCI) · Antiplatelet / ACS
- Diclofenac (Dysmenorrhoea / Post-gynaecological Procedure) · NSAID — Gynaecological Pain
- Difluprednate 0.05% Eye Drops · Potent Ophthalmic Corticosteroid — Uveitis / Post-Operative Inflammation
- Bromfenac · Topical NSAID (post-operative)
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The Rockall 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.