Rockall score for evaluation of upper gastrointestinal bleeding

Rockall score for the evaluation of upper gastrointestinalbleedingAge:< 60 years old60 to 79 years old>= 80 years oldShock:SBP>=100 mmHg + pulse<100 bpmSBP>=100mmHg + pulse>=100 bpmSBP< 100 mmHgcomorbidity:No major comorbidityHF,IHD,any major comorbidityRenal or liver failureDisseminated malignancyDiagnosis at endoscopy:Nml and no blood seenMallory-Weiss tearAll other diagnosesMalignancy of upper GI tractStigmata of recent hemorrhage:None or dark spot onlyBlood in upper GI tractAdherent clotVisible or spurting blood Background Info

The Rockall risk scoring system is based on clinical criteriaincluding age, shock and presence of other comorbidities. The scoring systemhelps evaluate patients at risk of re-bleeding or death following acuteupper gastrointestinal bleeding. The 1996 study recognized keyindependent risk factors which were later shown to predict mortalityaccurately. A commonly used mnemonic is ABCDE - (Age, Blood pressurefall (shock), Co-morbidity, Diagnosis and Evidence of bleeding).It is important to assess patients at admission to determine bleedingseverity and the potential risk of death.

Key independent risk factors:

Parameter

Finding

Points

Age

< 60 years

0

60 79 years

1

> 80 years

2

Shock

"No shock"; systolic blood pressure >= 100 mm Hg and pulse < 100 beats per minute

0

"Tachycardia"; systolic blood pressure >= 100 mm Hg and pulse >= 100 beats per minute

1

"Hypotension"; systolic blood pressure < 100 mm Hg

2

Comorbidity

no major comorbidity

0

hear failure, ischemic heart disease, or any major comorbidity

2

renal failure, liver failure, disseminated malignancy

3

Diagnosis at endoscopy

No lesion identified and no sign of recent hemorrhage

0

Mallory-Weiss tear

All other diagnoses

1

Malignancy of upper GI tract

2

Major stigmata of recent hemorrhage

None

0

Dark spot only

0

Blood in upper GI tract, adherent clot, visible or spurting blood

2

Score Prior to Endoscopy

Mortality

0

0.2%

1

2.4%

2

5.6%

3

11.0%

4

24.6%

5

39.6%

6

48.9%

7

50.0%

Post Endoscopy

Rebleed

Total Death

Death with No Rebleed

Death with Rebleed

0

4.9%

0%

0%

0%

1

3.4%

0%

0%

0%

2

5.3%

0.2%

0.3%

0%

3

11.2%

2.9%

2.0%

10.0%

4

14.1%

5.3%

3.5%

15.8%

5

24.1%

10.8%

8.1%

22.9%

6

32.9%

17.3%

9.5%

33.3%

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Rockall score for evaluation of upper gastrointestinal bleeding