‘Clinical features alone’ sufficient to assess need for small bowel obstruction surgery
Click Here to Manage Email Alerts
Key takeaways:
- Clinical features alone were comparable to CT imaging for determining small bowel obstruction surgery needs.
- Clinical features alone were also more accurate at any time after hospital admission.
Although CT imaging remains standard of care for determining surgical management needs for small bowel obstruction, clinical features alone performed equally well and with greater accuracy, according to data published in JAMA Network Open.
“Currently, computed tomography (CT) is the criterion standard for diagnosing [small bowel obstruction (SBO)] management,” Sara Schulwolf, BA, a medical student at UConn School of Medicine, and colleagues wrote. “However, practice variation exists due to a lack of definitive operative radiographic findings for SBO. We compared the ability of clinical features alone with that of clinical features combined with CT findings to estimate the need for surgical SBO management.”
Image: Adobe Stock
In a retrospective, multicenter health record review of adult patients admitted to 10 academic and community emergency departments from 2017 to 2020, Schulwolf and colleagues identified 4,478 cases of small bowel obstruction. Among these cases, 463 patients (10.3%) required surgery within 24 hours of presentation, 575 (12.8%) required surgery after 48 hours and 962 (21.5%) required surgery at any time during hospitalization.
The researchers compared the accuracy of using 22 clinical features alone or a combination of clinical features with 16 CT findings to determine the need for surgery to manage small bowel obstruction.
According to results, a model using 22 clinical features alone achieved similar results as the model combining clinical features with CT findings within 24 hours (AUROC = 0.78; 95% CI, 0.76-0.81) and 48 hours (AUROC = 0.77; 95% CI, 0.75-0.80) of hospital admittance. At all timepoints, clinical features alone (AUROC = 0.75; 95% CI, 0.73-0.78) were more accurate compared with clinical features plus CT findings (AUROC = 0.54; 95% CI, 0.51-0.57), the researchers noted.
“These findings suggest that clinical features alone may be sufficient to identify the need for surgery in patients with SBO,” Schulwolf and colleagues wrote. “Currently, more than 140,000 CT scans are performed on patients with suspected SBO annually. Our findings suggest that clinical features may risk stratify and identify patients who require urgent surgical intervention.”
Collapse
Read more about
Click Here to Manage Email Alerts