Abstract
IntroductionThe purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED) observation unit (OU) and to identify predictors of successful management for such patients.MethodsWe performed a retrospective chart review of 129 patients admitted to a university-affiliated, urban, tertiary hospital ED OU from January 1999 through November 2004. Inclusion criteria were all adult patients admitted to the OU with an ED diagnosis of ileus, partial small bowel obstruction, or small bowel obstruction, and electronic medical records available for review. The following variables were examined: ED diagnosis, history of similar admission, number of prior abdominal surgeries, surgery in the month before, administration of opioid analgesia at any time after presentation, radiographs demonstrating air–fluid levels or dilated loops of small bowel, hypokalemia, use of nasogastric decompression, and surgical consultation.ResultsTreatment failure, defined as hospital admission from the OU, occurred in 65 (50.4%) of 129 patients. Only the use of a nasogastric tube was associated with OU failure (21% discharged versus 79% requiring admission, P = 0.0004; odds ratio, 5.294; confidence interval, 1.982–14.14).ConclusionHalf of the patients admitted to our ED OU with ileus or varying degrees of small bowel obstruction required hospital admission. The requirement of a nasogastric tube in such patients was associated with a greater rate of observation unit failure.
Highlights
The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED) observation unit (OU) and to identify predictors of successful management for such patients
The use of a nasogastric tube was associated with OU failure (21% discharged versus 79% requiring admission, P 1⁄4 0.0004; odds ratio, 5.294; confidence interval, 1.982–14.14)
Half of the patients admitted to our ED OU with ileus or varying degrees of small bowel obstruction required hospital admission
Summary
The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED) observation unit (OU) and to identify predictors of successful management for such patients. The primary objective for the emergency physician (EP) in the evaluation of patients with abdominal pain is to detect conditions requiring urgent surgical intervention, because prompt recognition might obviate the potential morbidity and mortality associated with delays in diagnosis Conditions such as acute appendicitis generally require prompt operative intervention, surgeons often manage presumed partial bowel obstruction and adynamic ileus expectantly with observation and serial examinations.
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