The Rockall score: Risk assessment after acute upper gastrointestinal haemorrhage [Classics Series]

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1. Age, shock, comorbidity, diagnosis, major stigmata of recent haemorrhage, and rebleeding were found to be independent predictors of mortality following acute upper gastrointestinal haemorrhage.

Original Date of Publication: March 1996

Study Rundown: Acute upper gastrointestinal haemorrhage is a common medical emergency. Risk factors for rebleeding and death were well known at the time of this study’s publication but there was previously no clinically useful tool for risk stratifying patients. The Rockall risk scoring system was found to be a good indicator of prognosis following acute upper gastrointestinal haemorrhage. Rebleeding was identified as a particularly important risk factor associated with a five-fold increase in mortality among middle risk groups. Current treatment protocols specifically target the prevention of rebleeding due to the increased risk of mortality. It was intended that the Rockall score be applied in disease management, determining case mix in evaluating outcomes, developing treatment protocols, and selecting patients in clinical trials.

Click to read study in Gut

In-Depth [randomized, controlled study]: Published in Gut in 1996, this study produced a risk scoring system following acute upper gastrointestinal bleeding based on data from 4,185 cases identified in 1993 and 1,625 cases identified in 1994. In the first phase of data collection, medical staff completed a questionnaire for each identified case, which included risk factors, treatment, endoscopic findings, diagnosis, complications, and mortality. Multiple regression analysis found that the following variables were independent predictors of mortality: age, shock, comorbidity, diagnosis, major stigmata of recent haemorrhage, and rebleeding. The risk scoring system was validated using the second phase of data collection. An integer score was assigned to each category of each significant variable according to its contribution to the logistic regression model. The maximum possible score is 11 with scores of 8 or more considered very high risk categories. Rebleeding occurred in less than 5% of cases and mortality was close to zero in patients scoring 0, 1, or 2.

By Adrienne Cheung and Andrew Cheung, M.D.

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