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Wassmer CH, Revol R, Uhe I, Chevallay M, Toso C, Gervaz P, Morel P, Ris F, Schwenter F, Perneger T, Meier R. A new clinical severity score for the management of acute small bowel obstruction. Br J Surg 2021. [DOI: 10.1093/bjs/znab202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a non-viable small bowel remains a challenge. We aimed to identify risk factors for intestinal resection in patients with SBO and to develop a practical clinical score designed to guide surgical vs. conservative management.
Methods
We performed a prospective cohort study and included all patients admitted for an acute SBO between 2007 and 2016 in our center. Patients were divided in three categories: conservative management, surgical treatment with or without bowel resection. Clinical variables were assessed and compared between groups. Logistic regression models were used to identify the best predictors.
Results
604 patients were included in this study. 438 (73%) had surgery of which 127 (21%) had small bowel resection. 166 (27%) patients were treated conservatively. Among 13 clinical variables, univariate and multivariate logistic regression models identified 8 variables with a strong association with small bowel resection: age ≥70 years, a first episode of SBO, absence of bowel movement for ≥3 days, abdominal guarding, C-reactive protein ≥50, and 3 signs on abdominal CT-scan, namely, small bowel transition point, lack of small bowel contrast enhancement, and the presence of > 500 mL of intra-abdominal fluid. Each variable was given one point. We observed that 71-100% of patients with ≥4 points required a surgical resection. Sensitivity and specificity of this score were 65% and 88%, respectively and the area under the curve (AUC) was 0.84 (95% CI 0.80-0.89). Additionally, we propose two variants of the 8-tem score: a 7-item score excluding the lack of contrast enhancement, specifically designed for patient with contrast allergies or renal insufficiency, and a simplified 4-item score leaving age, guarding, transition zone on CT-scan, and the presence of 500 mL of fluid on CT scan. Both scores showed similar performances compared to the 8-item score with an AUC of 0.83 and 0.80 for the 7- and 4-item scores, respectively.
Conclusion
We developed a practical clinical severity score designed to tailor management of patients presenting with a SBO. A score of ≥ 4 points indicates the need for surgical exploration given the high likelihood of small bowel ischemia in these patients.
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Affiliation(s)
- C -H Wassmer
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R Revol
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - I Uhe
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - M Chevallay
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - C Toso
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - P Gervaz
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - P Morel
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - F Ris
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - F Schwenter
- Department of Surgery, Montreal University Hospital CHUM, Montreal, Canada
| | - T Perneger
- Division of Clinical Epidemiology, Geneva University Hospital, Geneva, Switzerland
| | - R Meier
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Department of Surgery and Transplantation, University of Maryland School of Medecine, Baltimore, USA
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Revol R, Rault C, Polard E, Bellet F, Guy C. Les hyponatrémies sous ISRS/IRSNA : étude épidémiologique descriptive et comparative des taux d’incidence de cas notifiés à partir des données de la Banque nationale de pharmacovigilance et de l’Assurance maladie. Encephale 2018; 44:291-296. [PMID: 29248119 DOI: 10.1016/j.encep.2017.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/01/2022]
Affiliation(s)
- R Revol
- Centre de pharmacovigilance, hôpital Nord, bâtiment A niveau 0, CHU de St-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - C Rault
- Centre régional de pharmacovigilance, CHRU hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - E Polard
- Centre régional de pharmacovigilance, CHRU hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - F Bellet
- Centre de pharmacovigilance, hôpital Nord, bâtiment A niveau 0, CHU de St-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - C Guy
- Centre de pharmacovigilance, hôpital Nord, bâtiment A niveau 0, CHU de St-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
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Thiers H, Revol R, Romagny G, Moulin G, Cuffia C, Silié M. [Erythema elevatum diutinum associated with other manifestations of cutaneous allergic angionecrosis]. Bull Soc Fr Dermatol Syphiligr 1966; 73:150-1. [PMID: 5914155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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