# Glasgow-Blatchford and Rockall Scores > Glasgow-Blatchford and Rockall scores for NEET-PG Medicine: upper GI bleed risk stratification, outpatient eligibility, endoscopic stigmata and mortality. - Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/glasgow-blatchford-and-rockall-scores - Exam / course: NEET-PG · Subject: Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Harrison's Principles of Internal Medicine; Bailey & Love's Short Practice of Surgery - How to cite: "Glasgow-Blatchford and Rockall Scores", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/glasgow-blatchford-and-rockall-scores ## Direct answer The Glasgow-Blatchford score is a pre-endoscopy tool that predicts the need for transfusion, endoscopic therapy, surgery or death in upper gastrointestinal bleeding. A score of 0 or 1 identifies patients who may be managed as outpatients. The Rockall score adds endoscopic findings to clinical variables, estimating rebleeding and mortality after endoscopy, with a complete score ranging from 0 to 11. ## What you must remember - **Glasgow-Blatchford range:** 0 to 23, with 0 or 1 identifying very low risk suitable for outpatient management. - **Blatchford components:** blood urea, haemoglobin, systolic blood pressure, pulse of 100 or more, melaena, syncope, hepatic disease and cardiac failure. - **Haemoglobin points:** a level below 10 g/dL scores 6 in both sexes, with lesser points for higher thresholds that differ by sex. - **Rockall range:** the pre-endoscopy score runs from 0 to 7, and the complete score runs from 0 to 11. - **Rockall components:** age, shock, comorbidity, endoscopic diagnosis and stigmata of recent haemorrhage. - **Endoscopic diagnosis:** a Mallory-Weiss tear or no lesion scores 0, while upper GI malignancy scores 2. - **High-risk stigmata:** a visible vessel or adherent clot scores 2 and warrants endoscopic therapy, such as clipping, thermal coagulation or injection. - **Scope:** the Glasgow-Blatchford score is designed for upper GI bleeding and is not validated for lower GI bleeding. ## A pathway from presentation to disposition Resuscitation always comes before scoring, and the scores then decide whether the patient needs endoscopy, therapy or admission. The sequence below mirrors how the scores are used in practice. 1. **Resuscitate first:** Establish venous access, correct shock and check haemoglobin, urea and coagulation before scoring. A patient in shock is not a candidate for outpatient management, whatever the score. 2. **Calculate Glasgow-Blatchford:** Score urea, haemoglobin, blood pressure, pulse, melaena, syncope, hepatic disease and cardiac failure before endoscopy. A score of 0 or 1 supports outpatient care after clinical review. 3. **Endoscope in time:** Patients above the low-risk threshold undergo upper endoscopy, usually within 24 hours of presentation. 4. **Calculate the complete Rockall score:** Add endoscopic diagnosis and stigmata of haemorrhage to the clinical components, giving a total from 0 to 11. 5. **Treat high-risk stigmata:** Visible vessels and adherent clots need endoscopic therapy, followed by a proton pump inhibitor regimen to reduce rebleeding. 6. **Plan disposition:** Higher scores warrant admission and monitoring, while a low complete Rockall score supports early discharge once rebleeding risk is judged low. ## Where the exam tries to catch you The exam tests which score applies at which stage, and which features each score counts. - **Trap:** using the Rockall pre-endoscopy score to decide outpatient care — **Correct:** Glasgow-Blatchford is the triage tool before endoscopy, while the complete Rockall score is completed after endoscopy. - **Trap:** assuming a normal haemoglobin excludes significant bleeding — **Correct:** haemoglobin can be normal early in acute bleeding, so serial measurements and the pulse matter. - **Trap:** scoring a Mallory-Weiss tear as a high-risk lesion — **Correct:** Rockall gives 0 points for a Mallory-Weiss tear or no lesion, and 2 points only for upper GI malignancy. - **Trap:** applying the Glasgow-Blatchford score to a patient with lower GI bleeding — **Correct:** the score was developed for upper GI bleeding and is not validated for lower GI sources. ## Frequently asked questions ### What range does the Glasgow-Blatchford score use? The Glasgow-Blatchford score ranges from 0 to 23, with higher totals indicating a greater need for transfusion, endoscopic therapy, surgery or death. A score of 0 or 1 identifies patients who can be considered for outpatient management. ### Which components make up the complete Rockall score? The complete Rockall score combines age, shock, comorbidity, endoscopic diagnosis and stigmata of recent haemorrhage, with a maximum of 11. The pre-endoscopy Rockall score uses only age, shock and comorbidity, with a maximum of 7. ### Why does the Rockall score include endoscopic findings? Endoscopic diagnosis and stigmata of recent haemorrhage reveal the actual lesion and its rebleeding risk, which the clinical history cannot show. Visible vessels and adherent clots carry the highest risk and need endoscopic therapy. ### Which bleeding is the Glasgow-Blatchford score designed for? The Glasgow-Blatchford score is designed for upper gastrointestinal bleeding, such as haematemesis or melaena from the oesophagus, stomach or duodenum. It is not validated for lower gastrointestinal bleeding.