Key result
A prediction model score of ≥ 2, based on white blood cell count ≥ 12000/µL and unenhanced CT peritoneal fluid value ≥ 20 HU, strongly predicted irreversible intestinal ischemia requiring bowel resection (OR 15.938).
Why the study?
Preoperatively diagnosing irreversible intestinal ischemia in patients with strangulated bowel obstruction is difficult.
Does a prediction model using WBC count and CT peritoneal fluid attenuation predict irreversible intestinal ischemia in patients with strangulated bowel obstruction?
Cohort (n=83)
No
Does a prediction model using WBC count and CT peritoneal fluid attenuation predict irreversible intestinal ischemia in patients with strangulated bowel obstruction?
Odds Ratio: 15.938 (95% CI 5.086–49.95)
p-value: p=<0.001
A simple scoring model using WBC count and unenhanced CT peritoneal fluid attenuation can accurately predict the need for bowel resection in patients with strangulated bowel obstruction.
May support risk stratification for resection in strangulated obstruction; leaves open prospective validation before clinical use.
Background: Preoperatively diagnosing irreversible intestinal ischemia in patients with strangulated bowel obstruction is difficult. Therefore, this study aimed to establish a prediction model for irreversible intestinal ischemia in strangulated bowel obstruction.Methods: We included 83 patients who underwent emergency surgery for strangulated bowel obstruction between January 2014 and March 2022. The predictors of irreversible intestinal ischemia in strangulated bowel obstruction were identified using logistic regression analysis, and a prediction model for irreversible intestinal ischemia in strangulated bowel obstruction was established using the regression coefficients. Receiver operating characteristic analysis and 5-fold cross-validation was used to assess the model.Results: The prediction model (range, 0−4) was established using a white blood cell count of ≥ 12000/µL and the computed tomography value of peritoneal fluid that was ≥ 20 Hounsfield units. The areas of the receiver operating characteristic curve of the new prediction model were 0.814 and 0.807 after 5-fold cross-validation. A score of ≥ 2 was strongly suggestive of irreversible intestinal ischemia in strangulated bowel obstruction and necessitated bowel resection (odds ratio = 15.938). The bowel resection rates for the prediction scores of 0, 2, and 4 were 15.2%, 66.7%, and 85.0%, respectively.Conclusions: Our model may help predict irreversible intestinal ischemia that necessitates bowel resection for strangulated bowel obstruction cases and thus enable surgeons to recognize the severity of the situation and prepare for deterioration of patients with progression of intestinal ischemia.
No takes yet. Share an insight, caveat, or question.
Kobayashi et al. (2022) conducted a cohort in Strangulated bowel obstruction (n=83). Prediction model score ≥ 2 (WBC ≥ 12000/µL and CT peritoneal fluid ≥ 20 HU) vs. Prediction model score < 2 was evaluated on Irreversible intestinal ischemia necessitating bowel resection (OR 15.938, 95% CI 5.086-49.95, p=<0.001). A prediction model score of ≥ 2, based on white blood cell count ≥ 12000/µL and unenhanced CT peritoneal fluid value ≥ 20 HU, strongly predicted irreversible intestinal ischemia requiring bowel resection (OR 15.938).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: