A Prediction Model for Recognizing Strangulated Small Bowel Obstruction

Gastroenterology Research and Practice, Mar 2018

Introduction. Early and accurate diagnosis of strangulated small bowel obstruction (SSBO) is difficult. This study aimed to devise a prediction model for predicting the risk of SSBO. Materials and Methods. A database of 417 patients who had clinical symptoms of intestinal obstruction confirmed by computed tomography (CT) were evaluated for inclusion in this study. Symptoms and laboratory and radiologic findings of these patients were collected after admission. These clinical factors were analyzed using logistic regression. A logistic regression model was applied to identify determinant variables and construct a clinical score that would predict SSBO. Results. Seventy-six patients were confirmed to have SSBO, 169 patients required surgery but had no evidence of intestinal ischemia, and 172 patients were successfully managed conservatively. In multivariate logistic regression analysis, body temperature ≥ 38.0°C, positive peritoneal irritation sign, white blood cell (WBC) count > 10.0 × 10^9/L, thick-walled small bowel ≥3 mm, and ascites were significantly associated with SSBO. A new prediction model with total scores ranging from 0 to 481 was developed with these five variables. The area under the curve (AUC) of the new prediction model was 0.935. Conclusions. Our prediction model is a good predictive model to evaluate the severity of SBO.

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A Prediction Model for Recognizing Strangulated Small Bowel Obstruction

A Prediction Model for Recognizing Strangulated Small Bowel Obstruction Xiaming Huang,1 Guan Fang,1 Jie Lin,2 Keyu Xu,1 Hongqi Shi,1 and Lei Zhuang1 1Department of General Surgery, The First affiliated Hospital of Wenzhou Medical University, Wenzhou, China 2Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China Correspondence should be addressed to Hongqi Shi; moc.361@18891785781 and Lei Zhuang; moc.qq@268339345 Received 3 August 2017; Revised 17 December 2017; Accepted 26 December 2017; Published 26 March 2018 Academic Editor: Eiji Sakai Copyright © 2018 Xiaming Huang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction. Early and accurate diagnosis of strangulated small bowel obstruction (SSBO) is difficult. This study aimed to devise a prediction model for predicting the risk of SSBO. Materials and Methods. A database of 417 patients who had clinical symptoms of intestinal obstruction confirmed by computed tomography (CT) were evaluated for inclusion in this study. Symptoms and laboratory and radiologic findings of these patients were collected after admission. These clinical factors were analyzed using logistic regression. A logistic regression model was applied to identify determinant variables and construct a clinical score that would predict SSBO. Results. Seventy-six patients were confirmed to have SSBO, 169 patients required surgery but had no evidence of intestinal ischemia, and 172 patients were successfully managed conservatively. In multivariate logistic regression analysis, body temperature ≥ 38.0°C, positive peritoneal irritation sign, white blood cell (WBC) count > 10.0 × 10^9/L, thick-walled small bowel ≥3 mm, and ascites were significantly associated with SSBO. A new prediction model with total scores ranging from 0 to 481 was developed with these five variables. The area under the curve (AUC) of the new prediction model was 0.935. Conclusions. Our prediction model is a good predictive model to evaluate the severity of SBO. 1. Introduction Strangulated small bowel obstruction (SSBO) may lead to intestinal perforation, ischemia, and necrosis mainly due to compromised blood flow [1, 2]. It is reported that SBO accounts for 12% to 16% of surgical admissions, and no less than 300,000 surgical operations are performed in the United States every year [3]. A 35-year institutional experience revealed 42% of small bowel obstructions (SBO) to be due to strangulation. Meanwhile, nonviable strangulation accounts for 16% of SBOs, which have a fourfold increase in the risk of death compared to viable strangulation [4]. Another study reported that patients with strangulated obstruction have 2 to 10 times higher rates of death than those with nonstrangulated obstruction [5, 6]. Thus, in order to prevent strangulation and potential bowel necrosis leading to higher morbidity and mortality rate, prompt differentiation of the characteristics of SBO is needed [6, 7]. Strangulated obstruction may require immediate surgical intervention [5]. In-hospital mortality in patients who underwent emergency gastrointestinal (GI) surgery was associated with cancer-related peritonitis, preoperative anemia, and preoperative hypoalbuminemia [8]. Older patients older than 90 years who underwent emergency surgery had a higher mortality rate than younger patients [9]. Furthermore, some studies showed that a large number of non-SSBO cases could be successfully managed with conservative treatment [7, 10, 11]. Therefore, to avoid the risk of emergency surgery, patients without SSBO should be identified and managed conservatively. Clinical parameters, including medical history and physical examination, laboratory test, and imaging findings can provide a better evaluation of the risk of underlying bowel strangulation and help to establish an appropriate plan of SBO treatment [12, 13]. In this study, we aimed to devise a model for predicting the risk of SSBO. 2. Methods2.1. Study Population and Data Collection The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Wenzhou Medical University, and it conformed to the concepts of the declaration of Helsinki and its amendments. Between January 2007 and December 2015, 417 patients from The First Affiliated Hospital of Wenzhou Medical University with clinical symptoms of intestinal obstruction confirmed by CT were evaluated for inclusion in the study. Patients with large bowel obstruction, inguinal hernia, early postoperative SBO (occurring less than 30 days after abdominal operation), malignancy, and patients with a known history of ascites were excluded from this study. Collected clinical parameters during admission included age, sex, past history of abdominal surgery, duration of hospital stay, r (...truncated)


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Xiaming Huang, Guan Fang, Jie Lin, Keyu Xu, Hongqi Shi, Lei Zhuang. A Prediction Model for Recognizing Strangulated Small Bowel Obstruction, Gastroenterology Research and Practice, 2018, 2018, DOI: 10.1155/2018/7164648