Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction

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• 作者：Issei Komatsu ; Yasuharu Tokuda ; Gen Shimada ; Joshua L. Jacobs ; Hisashi Onodera
• 关键词：Adhesive small bowel obstruction ; Conservative management ; Laparotomy ; Clinical prediction rule ; Ascites
• 刊名：The American Journal of Surgery
• 出版年：2010
• 出版时间：August 2010
• 年：2010
• 卷：200
• 期：2
• 页码：215-223
• 全文大小：488 K

文摘

Background

Among patients with adhesive small bowel obstruction (ASBO) initially managed with a conservative strategy, predicting risk of operation is difficult.

Methods

We investigated ASBO patients at 2 different periods to derive and validate a clinical prediction model for risk of operation.

Results

One hundred fifty-four patients were enrolled into the derivation cohort and 96 into the validation cohort. Based on the derived scoring, including age ≥65 years, presence of ascites, and gastrointestinal drainage volume >500 mL on day 3, each patient was classified into 1 of 4 risk classes from low risk to high risk. When applied to the validation cohort, the positive predictive value (PPV) for operation in the high-risk class was 72 % , while the negative predictive value (NPV) in the low-risk class was 100 % with high sensitivity (100 % ) and specificity (96 % ).

Conclusions

The prediction model performs well for risk stratification of need for surgical intervention following conservative strategy among ASBO patients.