GIT

د. حسين محمد جمعه

اختصاصي الامراض الباطنة
البورد العربي
كلية طب الموصل
2012

Rockall score

Rockall risk scoring system attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding. Rockall et al. identified independent risk factors which were later shown to predict mortality accurately. The scoring system uses clinical criteria (increasing age, co-morbidity, shock) as well as endoscopic finding (diagnosis, stigmata of acute bleeding). It is named for Professor Tim Rockall, who was the main investigator and first author of the studies that led to its formulation.

The Rockall score is an established and useful system to assess upper gastrointestinal bleeding (UGIB). The Rockall system has been shown to represent an accurate and valid predictor of rebleeding and death, performing better in the latter than in the former. Rockall scores are designed to combine information such as the subject’s age, occurrence of shock assessed from systolic blood pressure readings and pulse rate, presence and severity of comorbid conditions, diagnosis and endoscopic stigmata of recent bleeding.

Summing up the different levels of a point grading system assigned to each of the components yields a subject’s risk score bounded on a scale of 0 to 11, with 11 representing the highest risk. Results of previous investigations and validations of the scoring system have highlighted that those with a score of </= 2 are associated with a very low rate of bleeding recurrences and death and, therefore, can be reasonably managed as outpatients.

Variable[2]

Score 0
Score 1
Score 2
Score 3
Age
<60
60- 79
>80


Shock
No shock
Pulse >100BP >100 Systolic
SBP <100

Comorbidity

Nil major

CHF, IHD, major morbidity

Renal failure, liver failure, metastatic cancer
Diagnosis
Mallory-Weiss
All other diagnoses
GI malignancy

Evidence of bleeding

None

Blood, adherent clot, spurting vessel

Interpretation
Total score is calculated by simple addition. A score less than 3 carries good prognosis but total score more than 8 carries high risk of mortality









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