title: Early surgical intervention for blunt bowel injury: the Bowel Injury Prediction Score (BIPS).
abstract: BACKGROUND
  Computed tomography (CT) scan of the abdomen has been used for 30 years to evaluate the stable blunt trauma patient. However, the early diagnosis of blunt hollow viscus injury (BHVI) remains a challenge. Delayed diagnosis and intervention of BHVI lead to significant morbidity and mortality. This study aimed to identify a combination of radiographic and clinical variables present at admission that could lead to earlier surgical intervention for BHVI.
  
  
  METHODS
  Significant predictors were identified through a retrospective review of all blunt trauma patients admitted to a Level 1 trauma center from 2005 to 2010 with an admission CT of the abdomen/pelvis and diagnosed with any mesenteric injury. The Bowel Injury Prediction Score (BIPS) was calculated based on the following three elements with a point given for each outcome: white blood cell count of 17.0 or greater, abdominal tenderness, and CT scan grade for mesenteric injury of 4 or higher.
  
  
  RESULTS
  A total of 18,927 blunt trauma patients were admitted during the study period. Of these, 380 had a mesenteric injury, 110 met inclusion criteria, 60 had a surgical intervention, and 43 had BHVI. Of the 110 study patients, 43 (39%) had an immediate operation, 17 (16%) had a delayed operation (>4 hours), and 50 (46%) had no surgical intervention. The median BIPS for the immediate and delayed group was 2, while for the no-surgery group, the score was 0. Patients with a BIPS of 2 or greater were 19 times more likely to have a BHVI than patients with a BIPS of less than 2 (odds ratio, 19.2; 95% confidence interval, 6.78-54.36; p < 0.001).
  
  
  CONCLUSIONS
  Three predictors (admission CT scan grade of mesenteric injury, white blood cell count, and abdominal tenderness) were used to create a new bowel injury score, with a score of 2 or greater being strongly associated with BHVI. Prospective validation of these retrospective findings is warranted to fully assess the accuracy of the BIPS.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the University of Texas Health Science Center at Houston, Department of Surgery, Division of Acute Care Surgery, Houston, Texas.
authors.forename: Michelle K
authors.initials: MK
authors.lastname: McNutt
authors.forename: Naga R
authors.initials: NR
authors.lastname: Chinapuvvula
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Beckmann
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Pommerening
authors.forename: Rece W
authors.initials: RW
authors.lastname: Laney
authors.forename: O Clark
authors.initials: OC
authors.lastname: West
authors.forename: Brijesh S
authors.initials: BS
authors.lastname: Gill
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Kozar
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Adams
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D013781:Texas; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery*