Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 28, 2006; 12(48): 7779-7785
Published online Dec 28, 2006. doi: 10.3748/wjg.v12.i48.7779
Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting
Robert A Enns, Yves M Gagnon, Alan N Barkun, David Armstrong, Jamie C Gregor, Richard N Fedorak, RUGBE Investigators Group
Robert A Enns, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
Yves M Gagnon, Occam Research & Consulting Inc., Vancouver, Canada
Alan N Barkun, Department of Medicine, Division of Gastroenterology, McGill University and the McGill University Health Center, Montreal, Canada
David Armstrong, Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Canada
Jamie C Gregor, Division of Gastroenterology, University of Western Ontario, London, Canada
Richard N Fedorak, Division of Gastroenterology, University of Alberta, Edmonton, Canada
Supported by the Canadian Association of Gastroenterology and an unrestricted grant from Altana Pharma Canada (formerly Byk Canada Inc.)
Correspondence to: Robert A Enns, MD, 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
Telephone: +1-604-6887017 Fax: +1-604-6892004
Received: August 12, 2006
Revised: August 28, 2006
Accepted: November 30, 2006
Published online: December 28, 2006
Abstract

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 χ2 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 χ2 goodness-of-fit test indicated an acceptable fit for the model [χ2 (8) = 12.83, P = 0.12]. For surgical procedures [χ2 (8) = 5.3, P = 0.73] and death [χ2 (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.

Keywords: Upper gastrointestinal bleeding; Nonvariceal; Predictors; Rockall; Outcomes