title: Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma.
abstract: BACKGROUND
  Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life threatening. To date, series of PI outcomes consist of case reports and small retrospective series.
  
  
  METHODS
  We conducted a retrospective multicenter study, involving eight centers, of PI from January 2001 to December 2010. Demographics, medical history, clinical presentation, and outcomes were collected. Primary outcome was the presence of pathologic PI defined as confirmed transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression and a regression tree analysis was used to generate a clinical prediction rule for pathologic PI.
  
  
  RESULTS
  During the 10-year study period, 500 patients with PI were identified. Of this number, 299 (60%) had benign disease, and 201 (40%) had pathologic PI. A wide variety of variables were statistically significant predictors of pathologic PI on univariate comparison. In the regression model, a lactate of 2.0 or greater was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation, and absent bowel sounds also demonstrating significance. Classification and regression tree analysis was used to create a clinical prediction rule. In this tree, the presence of a lactate value of 2.0 or greater and hypotension/vasopressor use had a predictive probability of 93.2%.
  
  
  CONCLUSIONS
  Discerning the clinical significance of PI remains a challenge. We identified the independent predictors of pathologic PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland 21201, USA. jjd3c@yahoo.com
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Matthew
authors.initials: M
authors.lastname: Lissauer
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Maung
authors.forename: Greta L
authors.initials: GL
authors.lastname: Piper
authors.forename: Thomas A
authors.initials: TA
authors.lastname: O'Callaghan
authors.forename: Xian
authors.initials: X
authors.lastname: Luo-Owen
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.forename: Alex
authors.initials: A
authors.lastname: Shestopalov
authors.forename: Wendell Drew
authors.initials: WD
authors.lastname: Fielder
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.forename: Alison
authors.initials: A
authors.lastname: Wilson
authors.forename: Jane
authors.initials: J
authors.lastname: Channel
authors.forename: Forrest O
authors.initials: FO
authors.lastname: Moore
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Paul
authors.forename: Steven
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012955:Societies, Medical; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods