title: A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery.
abstract: BACKGROUND
  For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings.
  
  
  METHODS
  This was a multi-institution prospective observational study for patients who were admitted with ASBO. Patients were excluded if their SBO were not managed conservative initially; were within 30 days postoperatively; were caused by external hernias, small bowel tumor, or intussusception; and were related to Crohn's disease. Clinical and laboratory variables were collected prospectively. CT findings were interpreted by a blinded designated radiologist. To identify significant predictors, we performed a multivariable regression analysis.
  
  
  RESULTS
  During 22 months, we enrolled 200 patients with ASBO. Patients' mean (SD) age was 60 (18) years; 50% were male. Fifty-two patients (26%) underwent surgery. Of those who underwent surgery, the median duration of nonoperative treatment was 1.5 days (interquartile range, 1-2.5 days). In the regression model, we identified no flatus (odds ratio [OR], 3.28; 95% confidence interval [CI], 1.51-7.12; p = 0.003), presence of free fluid on CT (OR, 2.59; 95% CI, 1.13-5.90; p = 0.023), and high-grade obstruction by CT (OR, 2.44; 95% CI, 1.10-5.43; p = 0.028) to be significant predictors for ASBO patients who may need early surgery.
  
  
  CONCLUSIONS
  In this study, we prospectively derived one clinical and two CT predictors which ASBO patients may benefit from an early surgical intervention. However, a future study to validate these predictors is needed.
  
  
  METHODS
  Therapeutic study, level III; prognostic study, level II.
authors: From the Division of Acute Care Surgery (N.K., V.P., S.M., J.B., L.G., A.L.T., P.R.), Department of Surgery, and Department of Radiology (B.K., H.A.), University of Arizona, Tucson, Arizona; Division of Acute Care Surgery (K.I., K.C.), Department of Surgery, and Department of Radiology (R.S.), University of Southern California, Los Angeles, California; Division of Acute Care Surgery (M.D., L.N.), Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors: Narong
authors: N
authors: Kulvatunyou
authors: Viraj
authors: V
authors: Pandit
authors: Sadoun
authors: S
authors: Moutamn
authors: Kenji
authors: K
authors: Inaba
authors: Konstantinos
authors: K
authors: Chouliaras
authors: Marc
authors: M
authors: DeMoya
authors: Leily
authors: L
authors: Naraghi
authors: Bobby
authors: B
authors: Kalb
authors: Hina
authors: H
authors: Arif
authors: Reddy
authors: R
authors: Sravanthi
authors: Bellal
authors: B
authors: Joseph
authors: Lynn
authors: L
authors: Gries
authors: Andrew L
authors: AL
authors: Tang
authors: Peter
authors: P
authors: Rhee
mesh_terms: D003287:Contrast Media; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014481:United States
chemical_list: D003287:Contrast Media