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Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian
Robert-A Enns1, Yves-M Gagnon, Alan-N Barkun
1Division 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
Insights
The Rockall scoring system accurately predicts death in patients with upper gastrointestinal bleeding. However, it shows poor performance in predicting rebleeding and the need for surgery.
Area of Science:
- Gastroenterology
- Clinical Risk Stratification
- Medical Informatics
Background:
- Non-variceal upper gastrointestinal bleeding (NVUGIB) is a significant cause of morbidity and mortality.
- Accurate risk stratification is crucial for guiding clinical management and resource allocation.
- The Rockall score is a widely used tool for assessing the risk of adverse outcomes in NVUGIB.
Purpose of the Study:
- To validate the predictive accuracy of the Rockall scoring system.
- To assess its performance in predicting rebleeding, need for surgical procedures, and death in NVUGIB patients.
- To evaluate the calibration and discriminative ability of the scoring system.
Main Methods:
- Data from 1869 patients with NVUGIB were extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy.
- Rockall risk scores were calculated for each patient.
- Chi-squared goodness-of-fit tests and receiver operating characteristic (ROC) curves with area under the curve (AUC) were used to assess model fit and discriminative ability.
Main Results:
- The Rockall score demonstrated acceptable calibration for predicting rebleeding, surgical procedures, and death.
- Discriminative ability (AUC) was poor for rebleeding (0.59) and surgical procedures (0.60).
- The scoring system showed acceptable discriminative ability for predicting death (AUC = 0.73).
Conclusions:
- The Rockall scoring system is a reliable tool for predicting mortality in patients with upper gastrointestinal bleeding.
- Its utility is limited in predicting rebleeding and the necessity of surgical intervention.
- Further refinement or alternative scoring systems may be needed for these specific outcomes.
Aim:
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.
Conclusion:
The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.
