Abstract
The diagnosis of acute small bowel obstruction (ASBO) may be difficult and the decision to operate is based on clinical findings. So far, the diagnostic scores (DSs) for ASBO detection have been rarely evaluated. A cohort of 1,333 acute abdominal pain (AAP) patients with 54 ASBO patients, were included in the study. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for ASBO diagnosis with location of pain at diagnosis (LP+) and without location of pain at diagnosis (LP-). Meta-analytical techniques were used to calculate the summary sensitivity (Se) and specificity (Sp) estimates for each data sets (history-taking, findings, and DS formulas). In SROC analysis, the AUC values for i) clinical history-taking, ii) diagnostic findings and tests, iii) DSLP- and iv) DSLP+ were as follows: i) AUC=0.638 (95%CI=0.600-0.676); ii) AUC=0.694 (95%CI=0.630-0.724), iii) AUC=0.962 (95%CI=0.940-0.986), and for iv) AUC=0.971 (95%CI=0.952-0.988). In roccomp analysis for the AUC values, the differences are significant as follows: between i) and ii) p=0.312; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.317. The present study is the first to provide data that the DS could be used for clinical diagnosis of ASBO without radiological or laboratory analyses, to reach a high diagnostic accuracy in AAP patients.
Highlights
The diagnosis of acute small bowel obstruction (ASBO) is sometimes difficult, the diagnosis and treatment of ASBO is necessary for intestinal preservation and avoiding the risk of complications
The lack of commonly accepted guidelines and diagnostic scoring (DS) for ASBO [1] encouraged us to evaluate the accuracy of the clinical diagnosis of ASBO among abdominal pain (AAP) patients
We designed the present study to assess the relative accuracy of i) a clinical history-taking, ii) clinical findings, as well as iii) the Diagnostic score (DS) without location of pain at diagnosis (LP–) and iv) the DS with location of pain at diagnosis (LP+) in confirming ASBO among the patients with AAP
Summary
The diagnosis of acute small bowel obstruction (ASBO) is sometimes difficult, the diagnosis and treatment of ASBO is necessary for intestinal preservation and avoiding the risk of complications. The clinical findings of ASBO include signs of peritoneal irritation and the acute abdominal pain (AAP) with distension, abnormal bowel sounds and a history of abdominal surgery, because adhesions are complications of abdominal surgery and the most frequent etiology of ASBO [1, 2]. It is difficult to diagnose ASBO based on a single history-taking variable or a clinical finding. The decision of operation in patients with ASBO is based on doctor’s clinical judgement. We designed the present study to assess the relative accuracy of i) a clinical history-taking, ii) clinical findings, as well as iii) the DS without location of pain at diagnosis (LP–) and iv) the DS with location of pain at diagnosis (LP+) in confirming ASBO among the patients with AAP
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