Validation of the Rockall risk scoring system in upper gastrointestinal bleeding

被引:186
作者
Vreeburg, EM
Terwee, CB
Snel, P
Rauws, EAJ
Bartelsman, JFWM
van der Meulen, JHP
Tytgat, GNJ
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol & Biostat, NL-1100 DE Amsterdam, Netherlands
[2] Acad Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
[3] Slotervaart Hosp, Dept Gastroenterol, Slotervaart, Netherlands
关键词
upper gastrointestinal bleeding; risk scoring; prognostic factors; rebleeding; mortality;
D O I
10.1136/gut.44.3.331
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 chi(2) 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 Amsterdam, The Netherlands 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.
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页码:331 / 335
页数:5
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