Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention

Martin D. Zielinski, Patrick W. Eiken, Stephanie F. Heller, Christine M. Lohse, Marianne Huebner, Michael G. Sarr, Michael P. Bannon

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Abstract

Background: We published previously a model predictive of the need for exploration in small-bowel obstruction. We aimed to validate and refine the model, hypothesizing that the model would be predictive, would prevent delayed management of strangulation, and would be successfully improved. Study Design: Data from 100 consecutive patients with small-bowel obstruction and concurrent CT were collected prospectively. New features evaluated included obstipation and the absence of colonic gas on CT. Results: Overall mortality was 8%. Twenty-nine patients had all 4 clinical features, 22 of whom required operative exploration (concordance index = 0.75), confirming the validity of the old model. Intraperitoneal free fluid (odds ratio [OR]: 2.6, 95% CI: 1.0 to 6.9) and vomiting (OR: 1.5, 95% CI: 0.5 to 4.5) were not predictive of operative exploration; however, mesenteric edema (OR: 4.2, 95% CI: 1.1 to 15.8) and lack of the small-bowel feces sign were (OR: 3.5, 95% CI: 1.4 to 8.8). Obstipation was associated with the need for exploration (OR: 2.8, 95% CI: 1.2 to 6.6), but absence of colonic gas was not. A new model was equally predictive of the need for exploration: mesenteric edema (OR: 5.6, 95% CI: 1.5 to 20.7), lack of the small-bowel feces sign (OR: 5.1, 95% CI: 1.9 to 13.6), and obstipation (OR: 3.2, 95% CI: 1.2 to 8.3). The concordance index for this new model was 0.77. Conclusions: Our current prospective study validated our original model and was successfully improved. Our new model demonstrated equivalent predictive ability and was simpler to use. When all 3 features of the new model are present, strong consideration for early operative exploration should be entertained and may decrease the rate of missed strangulation obstructions.

Original languageEnglish (US)
Pages (from-to)1068-1076
Number of pages9
JournalJournal of the American College of Surgeons
Volume212
Issue number6
DOIs
StatePublished - Jun 2011

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Odds Ratio
Feces
Edema
Gases
Vomiting
Prospective Studies
Mortality

ASJC Scopus subject areas

  • Surgery

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Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. / Zielinski, Martin D.; Eiken, Patrick W.; Heller, Stephanie F.; Lohse, Christine M.; Huebner, Marianne; Sarr, Michael G.; Bannon, Michael P.

In: Journal of the American College of Surgeons, Vol. 212, No. 6, 06.2011, p. 1068-1076.

Research output: Contribution to journalArticle

Zielinski, Martin D. ; Eiken, Patrick W. ; Heller, Stephanie F. ; Lohse, Christine M. ; Huebner, Marianne ; Sarr, Michael G. ; Bannon, Michael P. / Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. In: Journal of the American College of Surgeons. 2011 ; Vol. 212, No. 6. pp. 1068-1076.
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abstract = "Background: We published previously a model predictive of the need for exploration in small-bowel obstruction. We aimed to validate and refine the model, hypothesizing that the model would be predictive, would prevent delayed management of strangulation, and would be successfully improved. Study Design: Data from 100 consecutive patients with small-bowel obstruction and concurrent CT were collected prospectively. New features evaluated included obstipation and the absence of colonic gas on CT. Results: Overall mortality was 8{\%}. Twenty-nine patients had all 4 clinical features, 22 of whom required operative exploration (concordance index = 0.75), confirming the validity of the old model. Intraperitoneal free fluid (odds ratio [OR]: 2.6, 95{\%} CI: 1.0 to 6.9) and vomiting (OR: 1.5, 95{\%} CI: 0.5 to 4.5) were not predictive of operative exploration; however, mesenteric edema (OR: 4.2, 95{\%} CI: 1.1 to 15.8) and lack of the small-bowel feces sign were (OR: 3.5, 95{\%} CI: 1.4 to 8.8). Obstipation was associated with the need for exploration (OR: 2.8, 95{\%} CI: 1.2 to 6.6), but absence of colonic gas was not. A new model was equally predictive of the need for exploration: mesenteric edema (OR: 5.6, 95{\%} CI: 1.5 to 20.7), lack of the small-bowel feces sign (OR: 5.1, 95{\%} CI: 1.9 to 13.6), and obstipation (OR: 3.2, 95{\%} CI: 1.2 to 8.3). The concordance index for this new model was 0.77. Conclusions: Our current prospective study validated our original model and was successfully improved. Our new model demonstrated equivalent predictive ability and was simpler to use. When all 3 features of the new model are present, strong consideration for early operative exploration should be entertained and may decrease the rate of missed strangulation obstructions.",
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AU - Zielinski, Martin D.

AU - Eiken, Patrick W.

AU - Heller, Stephanie F.

AU - Lohse, Christine M.

AU - Huebner, Marianne

AU - Sarr, Michael G.

AU - Bannon, Michael P.

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N2 - Background: We published previously a model predictive of the need for exploration in small-bowel obstruction. We aimed to validate and refine the model, hypothesizing that the model would be predictive, would prevent delayed management of strangulation, and would be successfully improved. Study Design: Data from 100 consecutive patients with small-bowel obstruction and concurrent CT were collected prospectively. New features evaluated included obstipation and the absence of colonic gas on CT. Results: Overall mortality was 8%. Twenty-nine patients had all 4 clinical features, 22 of whom required operative exploration (concordance index = 0.75), confirming the validity of the old model. Intraperitoneal free fluid (odds ratio [OR]: 2.6, 95% CI: 1.0 to 6.9) and vomiting (OR: 1.5, 95% CI: 0.5 to 4.5) were not predictive of operative exploration; however, mesenteric edema (OR: 4.2, 95% CI: 1.1 to 15.8) and lack of the small-bowel feces sign were (OR: 3.5, 95% CI: 1.4 to 8.8). Obstipation was associated with the need for exploration (OR: 2.8, 95% CI: 1.2 to 6.6), but absence of colonic gas was not. A new model was equally predictive of the need for exploration: mesenteric edema (OR: 5.6, 95% CI: 1.5 to 20.7), lack of the small-bowel feces sign (OR: 5.1, 95% CI: 1.9 to 13.6), and obstipation (OR: 3.2, 95% CI: 1.2 to 8.3). The concordance index for this new model was 0.77. Conclusions: Our current prospective study validated our original model and was successfully improved. Our new model demonstrated equivalent predictive ability and was simpler to use. When all 3 features of the new model are present, strong consideration for early operative exploration should be entertained and may decrease the rate of missed strangulation obstructions.

AB - Background: We published previously a model predictive of the need for exploration in small-bowel obstruction. We aimed to validate and refine the model, hypothesizing that the model would be predictive, would prevent delayed management of strangulation, and would be successfully improved. Study Design: Data from 100 consecutive patients with small-bowel obstruction and concurrent CT were collected prospectively. New features evaluated included obstipation and the absence of colonic gas on CT. Results: Overall mortality was 8%. Twenty-nine patients had all 4 clinical features, 22 of whom required operative exploration (concordance index = 0.75), confirming the validity of the old model. Intraperitoneal free fluid (odds ratio [OR]: 2.6, 95% CI: 1.0 to 6.9) and vomiting (OR: 1.5, 95% CI: 0.5 to 4.5) were not predictive of operative exploration; however, mesenteric edema (OR: 4.2, 95% CI: 1.1 to 15.8) and lack of the small-bowel feces sign were (OR: 3.5, 95% CI: 1.4 to 8.8). Obstipation was associated with the need for exploration (OR: 2.8, 95% CI: 1.2 to 6.6), but absence of colonic gas was not. A new model was equally predictive of the need for exploration: mesenteric edema (OR: 5.6, 95% CI: 1.5 to 20.7), lack of the small-bowel feces sign (OR: 5.1, 95% CI: 1.9 to 13.6), and obstipation (OR: 3.2, 95% CI: 1.2 to 8.3). The concordance index for this new model was 0.77. Conclusions: Our current prospective study validated our original model and was successfully improved. Our new model demonstrated equivalent predictive ability and was simpler to use. When all 3 features of the new model are present, strong consideration for early operative exploration should be entertained and may decrease the rate of missed strangulation obstructions.

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