Accurately evaluating for a small bowel obstruction using an abdominal radiograph, by a new method: The Bowel-Spine Ratio

Abstract

IntroductionA well-established method does not exist to rule out a small bowel obstruction using an abdominal xray series with significant accuracy. The hypothesis of the study is that the ratio of an average small bowel diameter to lumbar spine diameter over 0.5 is most likely a small bowel obstruction. MethodsAn x-ray abdominal series measurement technique was applied to 41 subjects with a chief complaint of “abdominal pain” as part of a randomized retrospective case review to predict an obstruction v. non obstruction. A total number of 81 abdominal pain subjects with a mean age of 46.7 years were selected with 40 excluded due to normal small bowel gas pattern. The subject's medical information was unknown to the authors when reading their images. The measurement technique involved averaging the largest and smallest small bowel short axis diameters with comparison to the lowest clearly visible lumbar body width. The subjects' medical course as described in the medical chart or subsequent computed tomography scans were used as the referencing standard to determine presence of obstruction vs non-obstruction. ResultsThis method, called the Bowel-Spine Ratio (BSR), resulted in a sensitivity of 0.882 (0.622–0.979; 95% CI), specificity of 0.957 (0.760–0.998; 95% CI), accuracy of 94.7% (80.9%–99.1%; 95% CI) and a positive likelihood ratio of 21 for predicting a small bowel obstruction. ConclusionThe abdominal series Bowel-Spine Ratio is a simple yet effective technique to screen for a small bowel obstruction using limited resources and to avoid unnecessary computed tomography scans with the potential to reduce health care costs. Implications for practice: Clinicians could have increased confidence in utilizing abdominal radiographs to evaluate for small bowel obstruction.