Role of Complete (Full) Rockall Scoring in Management of Upper Gastrointestinal Tract Bleeding

Background: Risk stratification in patients with upper gastrointestinal bleeding is very important for proper management. Rockall score is the most used scoring systems in this regards. Aims: to evaluate the Rockall scoring system as predictor of prognosis and mortality and accordingly management done in patients with upper gastrointestinal tract bleeding. Patients and Methods: This prospective study included 150 adult patients with upper gastrointestinal tract bleeding and underwent endoscopy. Demographic data- age, sex, presentation with hematochezia, and history of upper gastrointestinal tract bleeding, and comorbidities were recorded in a predesigned proforma. The Rockall Score was calculated according to standard protocol. The outcomes were measured in terms of need for medical ward, need for surgery and mortality were recorded 4 weeks after procedure. Receiver operating characteristic was used to evaluate the predicative value of Rockall score in predicting different outcomes (sensitivity and specificity of score). Results: Most patients (92, 61.13%) required medical ward admission, while the minority of patients (10, 6.67%) required surgical ward admission, 25 patients (16,67%) discharged home well, and 23 patients (13.33%) died. For predicting medical ward admission, the area under the curve was 0.803, 95%CI= 0.714-0.892. The sensitivity and specificity of the test at cut off value of Rockall score= 2 was 77% and 56%, respectively. For predicting surgical admission, the area under the curve was 0.927, 95%CI= 0.855-0.999. The sensitivity and specificity of the test at cut off value of Rockall score= 4 was 83% and 84%, respectively. For predicting mortality, the area under the curve was 0.982, 95%CI= 0.947-1.0. The sensitivity and specificity of the test at cut off value of Rockall score= 5 was 90% and 96%, respectively. Conclusions: The Rockall Score system is an appropriate predictor of mortality in patients with upper gastrointestinal tract bleeding. The cut-off point for predicting surgical admission and mortality was 4 and 5, respectively. However, it is not appropriate predictor for medical admission.