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Development of a simplified diagnostic indicators scoring system and validation for peptic ulcer perforation in a developing country

Authors Suriya C, Kasatpibal N, Kunaviktikul W, Kayee

Received 20 June 2012

Accepted for publication 27 August 2012

Published 25 September 2012 Volume 2012:5 Pages 187—194

DOI https://doi.org/10.2147/CEG.S35211

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3


Chutikarn Suriya,1 Nongyao Kasatpibal,2 Wipada Kunaviktikul,2 Toranee Kayee3

1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, 2Faculty of Nursing, Chiang Mai University, 3Department of Surgery, Nakornping Hospital, Chiang Mai, Thailand

Objective: To perform and confirm a simplified diagnostic indicators scoring system for predicting peptic ulcer perforation (PUP).
Methods: A case–control study was conducted including 812 consecutive patients with PUP from retrospective medical records. Each diagnostic indicator measurable at the time of admittance was analyzed by a multiple regression. Stepwise logistic regression was applied with backward elimination of statistically significant predictors from the full model, with P ≥ 0.05 for exclusion. The item scores were transformed from regression coefficients and computed to a total score. The risk of PUP was interpreted using total scores as a simple predictor. This system was internally validated in 218 consecutive patients and compared to existing systems.
Results: A PUP risk score was determined from the diagnostic indicators associated with PUP: gender, age, nonsteroidal antiinflammatory drugs used, history of peptic ulcer, intense abdominal pain, guarding, X-ray free air positive, and referral from other hospitals. Item scores ranged from 0–6.0 and the total score ranged from 0–34.0. The area under the receiver operating characteristic curve shows that there was 91.73% accuracy in the total scores predicting the likelihood of PUP. The likelihood of PUP among low risk (scores <10.5), moderate risk (scores 11–21), and high risk (scores ≥ 21.5) patients was 0.13, 11.44, and 1.95, respectively.
Conclusion: This scoring system is an effective diagnostic indicator for identifying the complex cases of PUP. It is a simple system and can help guide clinicians, providing them with a more efficient way to accurately subgroup patients while also reducing potential biases.

Keywords: peptic ulcer perforation, risk scoring, prediction

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