title: Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction.
abstract: 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 > or =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.
authors.affiliation: Department of Gastroenterological and General Surgery, St Luke's International Hospital, Chuo City, Tokyo, Japan. jr1cne@gmail.com
authors.forename: Issei
authors.initials: I
authors.lastname: Komatsu
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Gen
authors.initials: G
authors.lastname: Shimada
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Jacobs
authors.forename: Hisashi
authors.initials: H
authors.lastname: Onodera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D018570:Risk Assessment; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome