Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting.
OBJECTIVE
To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death.


METHODS
We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used chi2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system.


RESULTS
For rebleeding, the chi2 goodness-of-fit test indicated an acceptable fit for the model [chi2 (8) = 12.83, P = 0.12]. For surgical procedures [chi2 (8) = 5.3, P = 0.73] and death [chi2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI: 0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing a poor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78), indicating an acceptable discriminative ability.


CONCLUSIONS
The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.
Enns
Robert-A
RA
Division of Gastroenterology, Department of Medicine, St. Paul's Hospital, University of British Columbia, 300-1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada. renns@interchange.ubc.ca
Gagnon
Yves-M
YM
Barkun
Alan-N
AN
Armstrong
David
D
Gregor
Jamie-C
JC
Fedorak
Richard-N
RN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002170:Canada; D016009:Chi-Square Distribution; D002648:Child; D023381:Endpoint Determination / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome