Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction - 19/08/11
, Yasuharu Tokuda, M.D., M.P.H. b, Gen Shimada, M.D. a, c, Joshua L. Jacobs, M.D. b, d, Hisashi Onodera, M.D., Ph.D. a
Corresponding author. Tel.: +81 3 3541 5151; fax: +81 3 3544 0649Abstract |
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 ≥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.
Le texte complet de cet article est disponible en PDF.Keywords : Adhesive small bowel obstruction, Conservative management, Laparotomy, Clinical prediction rule, Ascites
Plan
Vol 200 - N° 2
P. 215-223 - août 2010 Retour au numéro
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