Validation of the Rockall risk scoring system in upper gastrointestinal bleeding
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...
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| Veröffentlicht in: | Gut 1999-03, Vol.44 (3), p.331-335 |
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| creator | Vreeburg, E M Terwee, C B Snel, P Rauws, E A J Bartelsman, J F W M Meulen, J H P vd Tytgat, G N J |
| description | 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 |
| doi_str_mv | 10.1136/gut.44.3.331 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1727413</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69588174</sourcerecordid><originalsourceid>FETCH-LOGICAL-b573t-f7c3f151ae2b393a6bbcfa1d56eec4b07f5a034aba94e7e83549ec9e8f1f21213</originalsourceid><addsrcrecordid>eNp90cuP0zAQBnALgdiycOOMLIHgQoodv-ILEpSnWPESVNysiet03TpxsRPE_vcYpVoWDpzmMD99mtGH0F1KlpQy-WQ7jUvOl2zJGL2GFpTLpmJ101xHC0KoqoTi-gTdynlHCGkaTW-iE0pILRmVC_RxDcFvYPRxwLHD47nDn6PdQwg4-bzH2cbkhy3OF3l0PfYDng4Hl_AW8piiH0aXRz9AwG1wblPkbXSjg5DdneM8RV9fvfyyelOdfXj9dvXsrGqFYmPVKcs6Kii4umWagWxb2wHdCOmc5S1RnQDCOLSguVOuYYJrZ7VrOtrVtKbsFD2dcw9T27uNdcOYIJhD8j2kCxPBm783gz832_jDUFUrTlkJeHgMSPH7VN4wvc_WhQCDi1M2UoumoYoXeP8fuItTKj_nkqW0lkRoWdTjWdkUc06uuzyFEvO7KFOKMpwbZkpRhd-7ev4VPDdTwIMjgGwhdAkG6_MfJzWpqSqsmpkv_fy8XEPaG6mYEub9emXEi-ffPr1babMu_tHs2373_wt_AUoquUo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1779960596</pqid></control><display><type>article</type><title>Validation of the Rockall risk scoring system in upper gastrointestinal bleeding</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Vreeburg, E M ; Terwee, C B ; Snel, P ; Rauws, E A J ; Bartelsman, J F W M ; Meulen, J H P vd ; Tytgat, G N J</creator><creatorcontrib>Vreeburg, E M ; Terwee, C B ; Snel, P ; Rauws, E A J ; Bartelsman, J F W M ; Meulen, J H P vd ; Tytgat, G N J</creatorcontrib><description>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.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>EISSN: 1458-3288</identifier><identifier>DOI: 10.1136/gut.44.3.331</identifier><identifier>PMID: 10026316</identifier><identifier>CODEN: GUTTAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Calibration - standards ; Child ; Child, Preschool ; Clinical medicine ; Endoscopy ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastrointestinal Hemorrhage - diagnosis ; Gastrointestinal Hemorrhage - mortality ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Intensive care ; Logistics ; Male ; Medical sciences ; Middle Aged ; Mortality ; Multivariate analysis ; Other diseases. Semiology ; Predictive Value of Tests ; prognostic factors ; Prospective Studies ; rebleeding ; Recurrence ; Reproducibility of Results ; Risk Assessment ; risk scoring ; ROC Curve ; Severity of Illness Index ; Stomach ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; upper gastrointestinal bleeding ; Validity ; Variables</subject><ispartof>Gut, 1999-03, Vol.44 (3), p.331-335</ispartof><rights>British Society of Gastroenterology</rights><rights>1999 INIST-CNRS</rights><rights>Copyright: 1999 British Society of Gastroenterology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b573t-f7c3f151ae2b393a6bbcfa1d56eec4b07f5a034aba94e7e83549ec9e8f1f21213</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1727413/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1727413/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1690217$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10026316$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vreeburg, E M</creatorcontrib><creatorcontrib>Terwee, C B</creatorcontrib><creatorcontrib>Snel, P</creatorcontrib><creatorcontrib>Rauws, E A J</creatorcontrib><creatorcontrib>Bartelsman, J F W M</creatorcontrib><creatorcontrib>Meulen, J H P vd</creatorcontrib><creatorcontrib>Tytgat, G N J</creatorcontrib><title>Validation of the Rockall risk scoring system in upper gastrointestinal bleeding</title><title>Gut</title><addtitle>Gut</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Calibration - standards</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical medicine</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastrointestinal Hemorrhage - diagnosis</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive care</subject><subject>Logistics</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Other diseases. Semiology</subject><subject>Predictive Value of Tests</subject><subject>prognostic factors</subject><subject>Prospective Studies</subject><subject>rebleeding</subject><subject>Recurrence</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment</subject><subject>risk scoring</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Stomach</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>upper gastrointestinal bleeding</subject><subject>Validity</subject><subject>Variables</subject><issn>0017-5749</issn><issn>1468-3288</issn><issn>1458-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp90cuP0zAQBnALgdiycOOMLIHgQoodv-ILEpSnWPESVNysiet03TpxsRPE_vcYpVoWDpzmMD99mtGH0F1KlpQy-WQ7jUvOl2zJGL2GFpTLpmJ101xHC0KoqoTi-gTdynlHCGkaTW-iE0pILRmVC_RxDcFvYPRxwLHD47nDn6PdQwg4-bzH2cbkhy3OF3l0PfYDng4Hl_AW8piiH0aXRz9AwG1wblPkbXSjg5DdneM8RV9fvfyyelOdfXj9dvXsrGqFYmPVKcs6Kii4umWagWxb2wHdCOmc5S1RnQDCOLSguVOuYYJrZ7VrOtrVtKbsFD2dcw9T27uNdcOYIJhD8j2kCxPBm783gz832_jDUFUrTlkJeHgMSPH7VN4wvc_WhQCDi1M2UoumoYoXeP8fuItTKj_nkqW0lkRoWdTjWdkUc06uuzyFEvO7KFOKMpwbZkpRhd-7ev4VPDdTwIMjgGwhdAkG6_MfJzWpqSqsmpkv_fy8XEPaG6mYEub9emXEi-ffPr1babMu_tHs2373_wt_AUoquUo</recordid><startdate>19990301</startdate><enddate>19990301</enddate><creator>Vreeburg, E M</creator><creator>Terwee, C B</creator><creator>Snel, P</creator><creator>Rauws, E A J</creator><creator>Bartelsman, J F W M</creator><creator>Meulen, J H P vd</creator><creator>Tytgat, G N J</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19990301</creationdate><title>Validation of the Rockall risk scoring system in upper gastrointestinal bleeding</title><author>Vreeburg, E M ; Terwee, C B ; Snel, P ; Rauws, E A J ; Bartelsman, J F W M ; Meulen, J H P vd ; Tytgat, G N J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b573t-f7c3f151ae2b393a6bbcfa1d56eec4b07f5a034aba94e7e83549ec9e8f1f21213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Calibration - standards</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical medicine</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastrointestinal Hemorrhage - diagnosis</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive care</topic><topic>Logistics</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Other diseases. Semiology</topic><topic>Predictive Value of Tests</topic><topic>prognostic factors</topic><topic>Prospective Studies</topic><topic>rebleeding</topic><topic>Recurrence</topic><topic>Reproducibility of Results</topic><topic>Risk Assessment</topic><topic>risk scoring</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Stomach</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>upper gastrointestinal bleeding</topic><topic>Validity</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vreeburg, E M</creatorcontrib><creatorcontrib>Terwee, C B</creatorcontrib><creatorcontrib>Snel, P</creatorcontrib><creatorcontrib>Rauws, E A J</creatorcontrib><creatorcontrib>Bartelsman, J F W M</creatorcontrib><creatorcontrib>Meulen, J H P vd</creatorcontrib><creatorcontrib>Tytgat, G N J</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vreeburg, E M</au><au>Terwee, C B</au><au>Snel, P</au><au>Rauws, E A J</au><au>Bartelsman, J F W M</au><au>Meulen, J H P vd</au><au>Tytgat, G N J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Validation of the Rockall risk scoring system in upper gastrointestinal bleeding</atitle><jtitle>Gut</jtitle><addtitle>Gut</addtitle><date>1999-03-01</date><risdate>1999</risdate><volume>44</volume><issue>3</issue><spage>331</spage><epage>335</epage><pages>331-335</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><eissn>1458-3288</eissn><coden>GUTTAK</coden><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.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>10026316</pmid><doi>10.1136/gut.44.3.331</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Calibration - standards Child Child, Preschool Clinical medicine Endoscopy Female Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal Hemorrhage - diagnosis Gastrointestinal Hemorrhage - mortality Hospitals Humans Infant Infant, Newborn Intensive care Logistics Male Medical sciences Middle Aged Mortality Multivariate analysis Other diseases. Semiology Predictive Value of Tests prognostic factors Prospective Studies rebleeding Recurrence Reproducibility of Results Risk Assessment risk scoring ROC Curve Severity of Illness Index Stomach Stomach. Duodenum. Small intestine. Colon. Rectum. Anus upper gastrointestinal bleeding Validity Variables |
| title | Validation of the Rockall risk scoring system in upper gastrointestinal bleeding |
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