A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study.
Int J Surg
; 109(6): 1620-1628, 2023 Jun 01.
Article
em En
| MEDLINE
| ID: mdl-37026805
ABSTRACT
BACKGROUND:
Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management. PATIENTS ANDMETHODS:
All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors.RESULTS:
Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500 ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI 0.80-0.89).CONCLUSION:
The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Traumatismos Abdominais
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Obstrução Intestinal
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
/
Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Humans
Idioma:
En
Revista:
Int J Surg
Ano de publicação:
2023
Tipo de documento:
Article