Rockall et al developed risk scores for evaluating patients with upper gastrointestinal tract hemorrhage. The score was developed by the National Audit of Acute Upper Gastrointestinal Hemorrhage by the Royal College of Surgeons in England.
Parameters for score:
(1) age
(2) shock
(3) comorbidity
(4) diagnosis at endoscopy
(5) major stigmata of recent hemorrhage
|
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 |
|
|
cardiac failure, ischemic heart disease, 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 |
0 |
|
|
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 |
where:
• Vreeburg et al modified the score by including a moderate comorbidity score (hypertension stable on medication, etc.) scored at 1 point.
• The scores were based on a multiple logistic regression analysis. The variables and coefficients for this model are given in Table II, page 318, Rockall (1996).
score prior to endoscopy =
= (points for age) + (points for shock) + (points for comorbidity)
score following endoscopy =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score prior to endoscopy: 7
• maximum score following endoscopy: 11
• The occurrence of rebleeding is associated with higher mortalities when the post-endoscopy Rockall scores are >= 3.
|
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% |
from Table IVA, page 319 Rockall (1996)
|
Score After 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% |
|
7 |
43.8% |
27.0% |
14.9% |
43.4% |
|
8 - 11 |
41.8% |
41.1% |
28.1% |
52.5% |
from Table IVB, page 319 Rockall (1996)
Performance of score:
• Vreeburg et al evaluated the scores in a population from the Netherlands. They found that the scores performed well in predicting mortality but poorly to predict rebleeding.
Specialty: Gastroenterology
