Validation of the anatomic severity score developed by the American Association for the Surgery of Trauma in small bowel obstruction

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• 作者：Yaser M.K. Baghdadi ; MD ; MSc ; David S. Morris ; MD ; Asad J. Choudhry ; MBBS ; Cornelius A. Thiels ; DO ; Mohammad A. Khasawneh ; MBBS ; Stephanie F. Polites ; MD ; Naeem Goussous ; MD ; Donald H. Jenkins ; MD ; Martin D. Zielinski ; MD ; ^{zielinski.martin@mayo.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Small bowel obstruction ; Standardized severity scoring system ; Emergency general surgery ; Outcomes ; Acute care surgery
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：204
• 期：2
• 页码：428-434
• 全文大小：411 K

文摘

The anatomic severity schema for small bowel obstruction (SBO) has been described by the American Association for the Surgery of Trauma (AAST). Although acknowledging the importance of physiological and comorbid parameters, these factors were not included in the developed system. Thus, we sought to validate the AAST-SBO scoring system and evaluate the effect of adding patient's physiology and comorbidity on the prediction for the proposed system.

Methods

Patients aged ≥18 y who were treated for SBO at our institution between 2009 and 2012 were identified. The physiology and comorbidity as well as the AAST anatomic scores were determined, squared, and added to calculate the score that we termed Acute General Emergency Surgical Severity-Small Bowel Obstruction (AGESS-SBO). The area under the receiver operating characteristic (AUROC) curve analyses were performed for the AAST anatomic score and compared with the AGESS-SBO score as a predictor for inhospital mortality, extended hospital stay, and inhospital complications.

Results

A total of 351 patients with mean age of 66 ± 17 years were identified, of whom 145 (41%) underwent operation to treat bowel obstruction. Extended hospital stay (>9 d) occurred in 86 patients (25%), inhospital complications in 73 (21%), and inhospital mortality in eight patients (2%). The median (interquartile range [IQR]) AAST anatomic score was 1 point (IQR: 1-2), physiology score was 0 point (IQR: 0-1), and comorbidity score was 1 point (IQR: 1-3); for overall median AGESS-SBO score of 5 points (IQR: 3-13). The AUROC curve analyses demonstrated that the AGESS-SBO system with measures of presenting physiology, comorbidities in addition to AAST anatomic criteria could be beneficial in predicting key outcomes including inhospital mortality (AUROC curve: 0.80 versus 0.54, P = 0.03).

Conclusions

The AAST anatomic score is a reliable system, which assists care providers to categorize SBO. Adding physiology and comorbidity parameters to the described anatomic criteria can be helpful in predicting the outcomes including mortality. Further studies evaluating its usefulness in research and quality improvement purposes across institutions are still required.