دورية أكاديمية
Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review.
| العنوان: | Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review. |
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| المؤلفون: | Eze VN; Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Parry T; Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Boone D; Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Mallett S; Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK., Halligan S; Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK. s.halligan@ucl.ac.uk. |
| المصدر: | European radiology [Eur Radiol] 2024 Jun; Vol. 34 (6), pp. 3861-3871. Date of Electronic Publication: 2023 Nov 08. |
| نوع المنشور: | Systematic Review; Journal Article; Meta-Analysis |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer International Country of Publication: Germany NLM ID: 9114774 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1084 (Electronic) Linking ISSN: 09387994 NLM ISO Abbreviation: Eur Radiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Berlin : Springer International, c1991- |
| مواضيع طبية MeSH: | Intestinal Obstruction*/surgery , Intestinal Obstruction*/diagnostic imaging , Intestine, Small*/surgery , Intestine, Small*/diagnostic imaging, Humans ; Prognosis ; Tomography, X-Ray Computed/methods |
| مستخلص: | Objectives: To identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction. Methods: Two researchers systematically reviewed indexed literature 2001-2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies. Results: Thirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36). Conclusions: Systematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery. Clinical Relevance Statement: Via systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility. Key Points: • While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely. • Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery. • Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility. (© 2023. The Author(s).) |
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| معلومات مُعتمدة: | UCLH Biomedical Research Centre UCLH Biomedical Research Centre |
| فهرسة مساهمة: | Keywords: CT; Intestinal ischaemia; Intestinal obstruction; Meta-analysis; Systematic review |
| تواريخ الأحداث: | Date Created: 20231108 Date Completed: 20240611 Latest Revision: 20240618 |
| رمز التحديث: | 20240618 |
| مُعرف محوري في PubMed: | PMC11166786 |
| DOI: | 10.1007/s00330-023-10421-9 |
| PMID: | 37938387 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1432-1084 |
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| DOI: | 10.1007/s00330-023-10421-9 |