Rockall Score

Predicts mortality and risk of rebleeding after upper gastrointestinal bleeding.

Gastroenterology GastroenterologyEvidence-BasedUpdated 2026-07

Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.

Clinical Notes

Higher Rockall Scores are associated with increased mortality and recurrent bleeding.

Calculator Information

Specialty

Gastroenterology

📋 Reference Ranges

Reference ranges for this calculator
Classification	Range
Low Risk	0–2
Moderate Risk	3–4
High Risk	≥5

What This Calculator Measures

Calculates the Rockall score to predict mortality and the risk of rebleeding after acute upper gastrointestinal bleeding using clinical and endoscopic findings.

How to Use

Select the age band, shock category, comorbidity, endoscopic diagnosis, and major stigmata of recent hemorrhage.
The full Rockall score requires endoscopic findings, so complete it after endoscopy.
Interpret the total score against the 0–2, 3–4, and ≥5 bands.

How the Calculation Works

The Rockall score sums weighted points across five components: age, shock, comorbidity, endoscopic diagnosis, and major stigmata of recent hemorrhage. Each component is selected as a pre-scored value (0-3) and summed; higher totals predict greater rebleeding and mortality risk.

Variables Explained

Age

Age category scored 0 (under 60 years), 1 (60-79 years), or 2 (80 years or older).

Shock

Hemodynamic status scored 0 (no shock), 1 (pulse over 100 bpm), or 2 (systolic BP under 100 mmHg).

Comorbidity

Comorbidity scored 0 (none), 2 (heart failure or ischemic heart disease), or 3 (renal failure, liver failure, or metastatic cancer).

Endoscopic Diagnosis

Endoscopic diagnosis scored 0 (Mallory-Weiss or no lesion), 1 (all other diagnoses), or 2 (upper GI malignancy).

Major Stigmata of Recent Hemorrhage

Endoscopic stigmata scored 0 (none or dark spot only) or 2 (blood in the tract, adherent clot, visible vessel, or active bleeding).

Interpretation Guide

Rockall 0–2 indicates low risk of mortality and rebleeding; 3–4 moderate risk with close monitoring; ≥5 high risk of mortality and recurrent bleeding requiring urgent specialist management.

Age-specific interpretation

Clinical Significance

The Rockall score is a well-validated tool for predicting mortality after upper GI bleeding and complements pre-endoscopy scores such as the Glasgow-Blatchford score.

When It Is Useful

Post-endoscopy risk stratification in upper GI bleeding
Estimating mortality in hospitalized patients with UGIB
Guiding the intensity of monitoring and follow-up endoscopy

When It Is Not Useful

Pre-endoscopy triage in the emergency department, where scores such as the Glasgow-Blatchford are used
Isolated lower GI bleeding
Children

Common Mistakes

Assigning endoscopic diagnosis and stigmata points before endoscopy has been performed, which either forces guesswork or produces a deceptively low total that understates true risk.
Using Rockall for emergency department triage or admission decisions, which is the role of the Glasgow-Blatchford score, since Rockall is applied after endoscopy to estimate mortality and rebleeding.
Scoring the shock category by diastolic blood pressure, when the options are defined by pulse above 100 bpm or systolic pressure below 100 mmHg.

Limitations

The full score requires endoscopic findings and cannot be completed before endoscopy.
Comorbidity weighting is coarse and may under-represent complex illness.
It predicts mortality/rebleeding but was not designed to decide pre-endoscopy admission.

Worked Example

An 82-year-old man presents with hematemesis. He is tachycardic but not hypotensive. Endoscopy shows a non-bleeding ulcer without major stigmata.

Inputs:

age: 2

shock: 1

comorbidity: 0

diagnosis: 1

stigmata: 0

Expected Result: Rockall score = 2 + 1 + 0 + 1 + 0 = 4 — moderate risk of mortality and rebleeding; close monitoring is recommended.

Evidence & References

Source:: Gastroenterology / Emergency Medicine
Reference:: Rockall TA, et al. Gut. 1996;38(3):316-321.
Content updated:: 2026-08

References

Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316-321. (Original score)

Frequently Asked Questions

Why can't the Rockall score be used before endoscopy?

Two of its five components, namely endoscopic diagnosis and major stigmata of recent hemorrhage, can only be completed once endoscopy has been done. A clinical-only version exists, but the full Rockall score used for mortality and rebleeding prediction requires those endoscopic findings, which is why pre-endoscopy risk stratification relies on the Glasgow-Blatchford score instead.

What counts as major stigmata of recent hemorrhage?

Within this calculator the stigmata component scores 0 for no stigmata or a dark spot only, and 2 for blood in the upper gastrointestinal tract, an adherent clot, a visible vessel, or active bleeding. These endoscopic findings carry much of the post-endoscopy risk estimate alongside diagnosis and comorbidity.

How does Rockall complement Glasgow-Blatchford in the same patient?

Glasgow-Blatchford is calculated at presentation using clinical and laboratory data to estimate the need for intervention and to guide admission decisions. After endoscopy, the Rockall score adds the endoscopic diagnosis and stigmata to age, shock, and comorbidity to estimate mortality and rebleeding risk. Many units use both, at different points in the same admission.

Disclaimer: This calculator is intended for educational and clinical decision support purposes only. Risk scores inform but do not replace clinical judgment in the management of upper GI bleeding.