دورية أكاديمية
A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia : a cohort study
| العنوان: | A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia : a cohort study |
|---|---|
| المؤلفون: | Wassmer, Charles-Henri, Revol, Rebecca, Uhe, Isabelle, Chevallay, Mickael Olivier Patrick, Toso, Christian, Gervaz, Pascal, Morel, Philippe, Poletti, Pierre-Alexandre Alois, Platon, Alexandra, Ris, Frédéric, Schwenter, Frank, Perneger, Thomas, Meier, Raphaël |
| المصدر: | ISSN: 1743-9159 ; International journal of surgery, vol. 109, no. 6 (2023) p. 1620-1628. |
| سنة النشر: | 2023 |
| المجموعة: | Université de Genève: Archive ouverte UNIGE |
| مصطلحات موضوعية: | info:eu-repo/classification/ddc/616.0757, info:eu-repo/classification/ddc/617, info:eu-repo/classification/ddc/618, Abdominal Injuries, Aged, Cohort Studies, Humans, Intestinal Obstruction / diagnosis, Intestinal Obstruction / etiology, Intestinal Obstruction / surgery, Ischemia / etiology, Prospective Studies, Retrospective Studies |
| الوصف: | Background: Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a non-viable small bowel remains a challenge. Through a prospective cohort study, we aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management. Materials and methods: All patients admitted for an acute SBO between 2004 and 2016 in our 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, first episode of SBO, no bowel movement for ≥3 days, abdominal guarding, C-reactive protein (CRP) ≥50, and three abdominal Computer Tomography scanner (CT-scan) signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of >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: We developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/37026805; https://archive-ouverte.unige.ch/unige:175833Test; unige:175833 |
| الإتاحة: | https://doi.org/10.1097/JS9.0000000000000171Test https://archive-ouverte.unige.ch/unige:175833Test |
| حقوق: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.F3E95A7A |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |