Rockall Score Calculator for Upper GI Bleeding
Calculate the original 1996 Rockall Score with direct age, pulse, systolic pressure, comorbidity, and optional post-endoscopy diagnosis/stigmata inputs.
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About
This Rockall Score calculator reproduces the original 1996 acute upper-GI-haemorrhage model for patients older than 16 years in the source audit cohorts. One page supports its clinical pre-endoscopy subtotal and its complete post-endoscopy total without treating them as separate formula revisions. [1]
The score was developed primarily to stratify mortality risk and support audit/case-mix comparison; rebleeding was also evaluated. It does not diagnose the bleeding source or prescribe disposition, endoscopy timing, transfusion, medication, procedure, or treatment. [1, 2]
Formula
Interpretation
| Complete score group | Rebleeding | Mortality |
|---|---|---|
| 0 | 4.9% | 0% |
| 1 | 3.4% | 0% |
| 2 | 5.3% | 0.2% |
| 3 | 11.2% | 2.9% |
| 4 | 14.1% | 5.3% |
| 5 | 24.1% | 10.8% |
| 6 | 32.9% | 17.3% |
| 7 | 43.8% | 27% |
| ≥8 | 41.8% | 41.1% |
Historical Rockall cohort observations only—not your probability, a calibrated current forecast, or a treatment/disposition instruction. The source groups all complete scores 8–11 in one ≥8 row; this page does not invent separate rates for 8, 9, 10, or 11. [1, 2]
Pre-endoscopy versus complete Rockall
Pre-endoscopy/admission Rockall uses age, derived shock, and the highest applicable comorbidity source category, for a maximum of 7. Complete/post-endoscopy Rockall adds endoscopic diagnosis and major stigmata of recent haemorrhage, for a maximum of 11. NICE currently specifies Blatchford at first assessment and full Rockall after endoscopy; it does not name pre-endoscopy Rockall as its preferred initial score. [1, 3]
Rockall versus GBS and AIMS65
- GBS: pre-endoscopy, intervention/hospital-treatment oriented, and used in current very-low-risk outpatient frameworks.
- AIMS65: pre-endoscopy and focused on in-hospital mortality stratification.
- Pre-Endoscopy Rockall: the original clinical subtotal for historical/admission prognostic stratification.
- Complete Rockall: adds initial endoscopic diagnosis and recent-haemorrhage stigmata for post-endoscopy mortality/rebleeding stratification.
These models are not interchangeable. In the 3,012-patient international comparison, GBS performed best for intervention/death; no evaluated score was especially useful for rebleeding. [4]
Historical outcomes and external validation
Complete scores ≤2 were historically described as a lower-risk group in the original cohorts, but this is not a modern automatic discharge rule. External validation found poorer rebleeding discrimination than mortality discrimination: AUC was about 0.61 versus 0.70 for rebleeding and 0.73 versus 0.81 for mortality in Vreeburg versus Rockall validation samples. Rebleeding calibration was poor, so the historical percentages remain cohort context rather than exact individual probabilities. [1, 2]
Current outpatient boundary
ACG 2021 uses GBS 0–1 as an example of a very-low-risk group for outpatient follow-up, and ESGE 2021 recommends GBS for pre-endoscopy stratification with GBS ≤1 for its very-low-risk outpatient framework. This calculator therefore never converts pre-Rockall 0, complete Rockall ≤2, or any higher score into discharge, admission, ICU, or urgent-endoscopy instructions. [5, 6]
What this result cannot decide
Rockall does not establish a bleeding diagnosis, rebleeding certainty, safe discharge, admission, ICU/HDU placement, transfusion, medication, reversal, endoscopy timing, endoscopic treatment, embolization, surgery, or another treatment. Clinical instability must not wait for an online score.
References
- Rockall TA, Logan RFA, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316–321. PMID 8675081. PMCID PMC1383057. DOI 10.1136/gut.38.3.316.
- Vreeburg EM, Terwee CB, Snel P, et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut. 1999;44(3):331–335. PMID 10026316. PMCID PMC1727413. DOI 10.1136/gut.44.3.331.
- National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. NICE guideline CG141. Risk assessment recommendations. Updated August 25, 2016. Accessed September 9, 2026.
- Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. PMID 28053181. PMCID PMC5217768. DOI 10.1136/bmj.i6432.
- Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899–917. PMID 33929377. DOI 10.14309/ajg.0000000000001245.
- Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: ESGE Guideline – Update 2021. Endoscopy. 2021;53(3):300–332. PMID 33567467. DOI 10.1055/a-1369-5274.
FAQ
The original 1996 Rockall Score is a staged prognostic score for acute upper gastrointestinal haemorrhage. Its pre-endoscopy subtotal uses age, shock and comorbidity; its complete score adds endoscopic diagnosis and major stigmata of recent haemorrhage.
Sources: [1]
Pre-endoscopy or admission Rockall uses only age, shock and comorbidity and has a maximum of 7. Complete or post-endoscopy Rockall adds diagnosis and major stigmata of recent haemorrhage and has a maximum of 11. They are two stages of the original model, not separate formula revisions.
Sources: [1]
Systolic pressure below 100 mmHg is hypotension and scores 2, regardless of pulse. Otherwise, systolic pressure at least 100 with pulse at least 100 scores 1 for tachycardia; systolic pressure at least 100 with pulse below 100 scores 0. Hypotension and tachycardia are never added together.
Sources: [1]
Systolic pressure exactly 100 mmHg is not in the below-100 hypotension band. With systolic pressure at least 100, pulse exactly 100 meets the inclusive tachycardia boundary and scores 1; pulse 99 scores 0 for shock.
Sources: [1]
Cardiac failure, ischemic heart disease, or another major comorbidity is the 2-point category. Renal failure, liver failure, or disseminated malignancy is the 3-point category. Select only the highest applicable source category; do not add 2 and 3.
Sources: [1]
No. The 3-point comorbidity wording is disseminated malignancy, not any malignancy. Malignancy of the upper gastrointestinal tract is separately a 2-point endoscopic diagnosis and may coexist only when both source categories independently apply.
Sources: [1]
Mallory-Weiss tear and no lesion identified with no recent-haemorrhage stigmata score 0; all other diagnoses score 1; malignancy of the upper gastrointestinal tract scores 2. Generic cancer is not substituted for upper-GI malignancy.
Sources: [1]
None or a dark spot only scores 0. Blood in the upper gastrointestinal tract, an adherent clot, or a visible or spurting vessel scores 2. The Rockall component has no intermediate 1-point stigmata category.
Sources: [1]
That diagnosis option is source-defined as no lesion identified and no stigmata of recent haemorrhage. Pairing it with a dark spot or major stigmata would be internally contradictory, so the calculator rejects the combination instead of silently scoring it.
Sources: [1]
GBS is pre-endoscopy and oriented to intervention/hospital-treatment outcomes and current very-low-risk outpatient frameworks. AIMS65 is pre-endoscopy and mortality-oriented. Rockall has a clinical pre-endoscopy subtotal and a complete score that requires endoscopic findings. They are not interchangeable.
No. Neither pre-Rockall 0, complete Rockall 2 or lower, nor any higher score independently determines discharge, admission, ICU placement, transfusion, medication, endoscopy timing, procedure, or treatment. Current ACG and ESGE very-low-risk outpatient examples use GBS, within a full clinical assessment.
Related Calculators
Glasgow-Blatchford Score
Calculate the original pre-endoscopy Glasgow-Blatchford Score for acute upper GI bleeding from measured urea/BUN, hemoglobin, blood pressure, pulse, and explicit clinical findings.
AIMS65 Score
Calculate the original Saltzman 2011 AIMS65 score from albumin, INR, altered mental status, systolic blood pressure, and age, with exact thresholds and historical mortality context.
Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.