A novel practical scoring for early diagnosis of traumatic bowel injury without obvious solid organ injury in hemodynamically stable patients.
OBJECTIVE
To develop a scoring tool based on clinical and radiological findings for early diagnosis and intervention in hemodynamically stable patients with traumatic bowel and mesenteric injury (TBMI) without obvious solid organ injury (SOI).


METHODS
A retrospective analysis was conducted for all traumatic abdominal injury patients in Qatar from 2008 to 2011. Data included demographics and clinical, radiological and operative findings. Multivariate logistic regression was performed to analyze the predictors for the need of therapeutic laparotomy.


RESULTS
A total of 105 patients met the inclusion criteria with a mean age of 33 ± 15. Motor Vehicle Crashes (58%) and fall (21%) were the major MOI. Using Receiver operating characteristic curve, Z-score of >9 was the cutoff point (AUC = 0.98) for high probability of the presence of TBMI requiring surgical intervention. Z-Score >9 was found to have sensitivity (96.7%), specificity (97.4%), PPV (93.5%) and NPV (98.7%). Multivariate regression analysis found Z-score (>9) to be an independent predictor for the need of exploratory laparotomy (OR7.0; 95% CI: 2.46-19.78, p = 0.001).


CONCLUSIONS
This novel tool for early diagnosis of TBMI is found to be simple and helpful in selecting stable patients with free intra-abdominal fluid without SOI for exploratory Laparotomy. However, further prospective studies are warranted.
Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar. Electronic address: ahmad.zarour@yahoo.com.
Ahmad
A
Zarour
Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Ayman
A
El-Menyar
General Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
Mazen
M
Khattabi
Oban Hospital, Argyll, UK.
Raed
R
Tayyem
King Hussein Cancer Center (KHCC), Amman, Jordan.
Osama
O
Hamed
Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
Ismail
I
Mahmood
Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
Husham
H
Abdelrahman
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
William
W
Chiu
Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
Hassan
H
Al-Thani
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011780:Qatar / Q000453:epidemiology; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D055815:Young Adult
Blunt trauma; Bowel injury; Intra-abdominal; Laparotomy; Scoring