Only the Boey Score Discriminates In-Hospital Mortality After Gastric Perforation: A STARD-Compliant Comparison with the Jabalpur Score

Abstract

Background: Gastric perforation remains a highly lethal surgical emergency, and competing preoperative mortality scores have not been compared directly in an Indonesian cohort.

Objective: To compare the discrimination, calibration, and clinical utility of the Boey and Jabalpur scores for in-hospital mortality after emergency surgery for gastric perforation.

Methods: This retrospective diagnostic-accuracy study, reported according to STARD 2015, included 55 consecutive adults who underwent emergency laparotomy for non-traumatic gastric perforation at a tertiary referral centre between January 2023 and September 2025. Both scores were evaluated against in-hospital death. Analyses included areas under the receiver operating characteristic curve, operating characteristics, calibration, and decision-curve analysis; quantities not identifiable from the aggregate source output were bounded rather than estimated.

Result: Twenty-nine patients (52.7%) died in hospital. The Boey score discriminated mortality (AUC 0.747, 95% CI 0.630–0.863), whereas the Jabalpur score did not (AUC 0.623, 95% CI 0.470–0.777; p = 0.118; power 34.1%). The AUC difference was 0.123, but its variance was not identifiable. At the optimal cut-offs, Boey ≥2 yielded 58.6% sensitivity and 73.1% specificity, while Jabalpur ≥10 yielded 69.0% sensitivity and 61.5% specificity. The published Boey risk table underpredicted mortality (observed-to-expected ratio 1.70), and decision-curve benefit was limited.

Conclusion: Only the Boey score separated survivors from decedents in this cohort. Formal superiority over the Jabalpur score remains unresolved, and the published Boey risk estimates require local recalibration before individual clinical use.