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Stomach
Validation of the Rockall risk scoring system in upper gastrointestinal bleeding
  1. E M Vreeburga,
  2. C B Terweec,
  3. P Snelb,
  4. E A J Rauwsa,
  5. J F W M Bartelsmana,
  6. J H P vd Meulenc,
  7. G N J Tytgata
  1. aDepartment of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands, bDepartment of Gastroenterology, Slotervaart Hospital, Slotervaart, The Netherlands, cDepartment of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands
  1. Ms C B Terwee, Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.

Abstract

BACKGROUND Several scoring systems have been developed to predict the risk of rebleeding or death in patients with upper gastrointestinal bleeding (UGIB). These risk scoring systems have not been validated in a new patient population outside the clinical context of the original study.

AIMS To assess internal and external validity of a simple risk scoring system recently developed by Rockall and coworkers.

METHODS Calibration and discrimination were assessed as measures of validity of the scoring system. Internal validity was assessed using an independent, but similar patient sample studied by Rockall and coworkers, after developing the scoring system (Rockall’s validation sample). External validity was assessed using patients admitted to several hospitals in Amsterdam (Vreeburg’s validation sample). Calibration was evaluated by a χ2 goodness of fit test, and discrimination was evaluated by calculating the area under the receiver operating characteristic (ROC) curve.

RESULTS Calibration indicated a poor fit in both validation samples for the prediction of rebleeding (p<0.0001, Vreeburg; p=0.007, Rockall), but a better fit for the prediction of mortality in both validation samples (p=0.2, Vreeburg; p=0.3, Rockall). The areas under the ROC curves were rather low in both validation samples for the prediction of rebleeding (0.61, Vreeburg; 0.70, Rockall), but higher for the prediction of mortality (0.73, Vreeburg; 0.81, Rockall).

CONCLUSIONS The risk scoring system developed by Rockall and coworkers is a clinically useful scoring system for stratifying patients with acute UGIB into high and low risk categories for mortality. For the prediction of rebleeding, however, the performance of this scoring system was unsatisfactory.

  • upper gastrointestinal bleeding
  • risk scoring
  • prognostic factors
  • rebleeding
  • mortality

  • Abbreviations

    ROC curve
    receiver operating characteristic curve
    SRH
    stigmata of recent haemorrhage
    UGIB
    upper gastrointestinal bleeding

    • https://doi.org/10.1136/gut.44.3.331

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    • Abbreviations

      ROC curve
      receiver operating characteristic curve
      SRH
      stigmata of recent haemorrhage
      UGIB
      upper gastrointestinal bleeding
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