Abstract
In order to better define management policies we attempted to construct risk models for rebleeding on initial conservative management and mortality after emergency surgery for failure of medical therapy in 387 patients with bleeding gastric ulcer. Several different models were constructed using logistic regression analysis with validation by the 'leaving-one-out' method. However, despite large patient numbers, modelling in this way is difficult because of inherent wide variation between patients. Suitable models for rebleeding were regarded as rather unsatisfactory, for although overall accuracy was 86%, sensitivity was only 54%. More promising was a model for mortality after emergency surgery which had an accuracy of 93% and a sensitivity of 80%. Such mortality models incorporating age, history of previous malignant disease or dyspepsia, the presence or absence of ascites and total transfusion requirements may well prove to be of value in surgical practice. This paper seeks to examine the process of modelling rebleeding and mortality and of interpreting the models produced.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Begg C. B., Greenes R. A. Assessment of diagnostic tests when disease verification is subject to selection bias. Biometrics. 1983 Mar;39(1):207–215. [PubMed] [Google Scholar]
- Bordley D. R., Mushlin A. I., Dolan J. G., Richardson W. S., Barry M., Polio J., Griner P. F. Early clinical signs identify low-risk patients with acute upper gastrointestinal hemorrhage. JAMA. 1985 Jun 14;253(22):3282–3285. [PubMed] [Google Scholar]
- Bornman P. C., Theodorou N. A., Shuttleworth R. D., Essel H. P., Marks I. N. Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):245–247. doi: 10.1136/bmj.291.6490.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brearley S., Hawker P. C., Morris D. L., Dykes P. W., Keighley M. R. Selection of patients for surgery following peptic ulcer haemorrhage. Br J Surg. 1987 Oct;74(10):893–896. doi: 10.1002/bjs.1800741008. [DOI] [PubMed] [Google Scholar]
- Clason A. E., Macleod D. A., Elton R. A. Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage. Br J Surg. 1986 Dec;73(12):985–987. doi: 10.1002/bjs.1800731213. [DOI] [PubMed] [Google Scholar]
- Pimpl W., Boeckl O., Waclawiczek H. W., Heinerman M. Estimation of the mortality rate of patients with severe gastroduodenal hemorrhage with the aid of a new scoring system. Endoscopy. 1987 May;19(3):101–106. doi: 10.1055/s-2007-1013010. [DOI] [PubMed] [Google Scholar]
- Wara P., Berg V., Amdrup E. Factors influencing mortality in patients with bleeding ulcer. Review of 7 years' experience preceding therapeutic endoscopy. Acta Chir Scand. 1983;149(8):775–785. [PubMed] [Google Scholar]
- Wara P. Endoscopic prediction of major rebleeding--a prospective study of stigmata of hemorrhage in bleeding ulcer. Gastroenterology. 1985 May;88(5 Pt 1):1209–1214. doi: 10.1016/s0016-5085(85)80081-0. [DOI] [PubMed] [Google Scholar]
- Wara P., Høst V., Stødkilde H. Clinical factors predisposing to major ulcer bleeding. A logistic regression analysis. Acta Chir Scand. 1985;151(4):349–354. [PubMed] [Google Scholar]