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Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury.

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Title: Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury.
Authors: Gupta, Shubham Kumar1, Singh, Pramod Kumar2, Sharma, Sumit1, Gupta, Sanjeev Kumar1 drsanjeevkgupta@gmail.com
Source: Trauma. Oct2024, Vol. 26 Issue 4, p337-346. 10p.
Subject Terms: *BLUNT trauma, *PREDICTIVE tests, *MESENTERY, *TRAFFIC accidents, *COMPUTED tomography, *CHI-squared test, *DESCRIPTIVE statistics, *ABDOMINAL injuries, *TRAUMA centers, *LONGITUDINAL method, *EARLY diagnosis, *DATA analysis software, *PREDICTIVE validity, *SENSITIVITY & specificity (Statistics), MESENTERY surgery
Geographic Terms: INDIA
Abstract: Background: Blunt bowel and mesenteric injuries (BBMI) are frequently missed despite the widespread use of computed tomography (CT). Early diagnosis for timely management of surgically significant blunt bowel and mesenteric injuries (sBBMI) can be challenging. Several tools predictive for sBBMI have been proposed such as the "Bowel Injury Prediction Score" (BIPS) that is based on presence of abdominal tenderness, white blood cell count ≥17,000/mm3 and CT grade. The utility of this scoring system for early diagnosis of sBBMI has neither been studied in an Indian population nor prospectively validated. Methods: A single-centre prospective cohort study was conducted at a Trauma Centre in India. After screening of 1793 patients with blunt trauma abdomen who presented between 1st January 2022 and 31st August 2022 and underwent CT scan, eventually, 80 patients of age >18 years, hemodynamically stable and CT finding suspicious of BBMI were included. BIPS score was calculated. Patients were followed to evaluate the outcome. Results: The incidence of sBBMI was 3.06%. Mean age of study patients was 36.2 ± 16.5 years with male predominance (92.5%) and road traffic accidents the commonest mode of injury. Patients with BBMI were more likely to require operative intervention in the presence of abdominal tenderness at presentation (p < 0.01) and CT grade ≥4 (p < 0.01). For patients with WBC counts of ≥17,000/mm3, no statistically significant difference was noted in the need for operative intervention. BIPS ≥2 had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI. Conclusion: Calculation of BIPS at the time of presentation can avoid unnecessary delays in surgical management and thereby reduce overall morbidity and mortality even in an Indian setup. However, WBC counts > 17,000/mm3 were not found to be predictive of sBBMI. [ABSTRACT FROM AUTHOR]
Copyright of Trauma is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gupta%2C+Shubham+Kumar%22&quot;&gt;Gupta, Shubham Kumar&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Singh%2C+Pramod+Kumar%22&quot;&gt;Singh, Pramod Kumar&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sharma%2C+Sumit%22&quot;&gt;Sharma, Sumit&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gupta%2C+Sanjeev+Kumar%22&quot;&gt;Gupta, Sanjeev Kumar&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;i&gt; drsanjeevkgupta@gmail.com&lt;/i&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Trauma%22&quot;&gt;Trauma&lt;/searchLink&gt;. Oct2024, Vol. 26 Issue 4, p337-346. 10p.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Blunt bowel and mesenteric injuries (BBMI) are frequently missed despite the widespread use of computed tomography (CT). Early diagnosis for timely management of surgically significant blunt bowel and mesenteric injuries (sBBMI) can be challenging. Several tools predictive for sBBMI have been proposed such as the &quot;Bowel Injury Prediction Score&quot; (BIPS) that is based on presence of abdominal tenderness, white blood cell count ≥17,000/mm3 and CT grade. The utility of this scoring system for early diagnosis of sBBMI has neither been studied in an Indian population nor prospectively validated. Methods: A single-centre prospective cohort study was conducted at a Trauma Centre in India. After screening of 1793 patients with blunt trauma abdomen who presented between 1st January 2022 and 31st August 2022 and underwent CT scan, eventually, 80 patients of age &gt;18 years, hemodynamically stable and CT finding suspicious of BBMI were included. BIPS score was calculated. Patients were followed to evaluate the outcome. Results: The incidence of sBBMI was 3.06%. Mean age of study patients was 36.2 &#177; 16.5 years with male predominance (92.5%) and road traffic accidents the commonest mode of injury. Patients with BBMI were more likely to require operative intervention in the presence of abdominal tenderness at presentation (p &lt; 0.01) and CT grade ≥4 (p &lt; 0.01). For patients with WBC counts of ≥17,000/mm3, no statistically significant difference was noted in the need for operative intervention. BIPS ≥2 had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI. Conclusion: Calculation of BIPS at the time of presentation can avoid unnecessary delays in surgical management and thereby reduce overall morbidity and mortality even in an Indian setup. However, WBC counts &gt; 17,000/mm3 were not found to be predictive of sBBMI. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of Trauma is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder&#39;s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1177/14604086231187523
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      – Code: eng
        Text: English
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        PageCount: 10
        StartPage: 337
    Subjects:
      – SubjectFull: INDIA
        Type: general
      – SubjectFull: BLUNT trauma
        Type: general
      – SubjectFull: PREDICTIVE tests
        Type: general
      – SubjectFull: MESENTERY
        Type: general
      – SubjectFull: TRAFFIC accidents
        Type: general
      – SubjectFull: COMPUTED tomography
        Type: general
      – SubjectFull: CHI-squared test
        Type: general
      – SubjectFull: DESCRIPTIVE statistics
        Type: general
      – SubjectFull: ABDOMINAL injuries
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      – SubjectFull: TRAUMA centers
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      – SubjectFull: LONGITUDINAL method
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      – SubjectFull: EARLY diagnosis
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      – SubjectFull: DATA analysis software
        Type: general
      – SubjectFull: PREDICTIVE validity
        Type: general
      – SubjectFull: SENSITIVITY & specificity (Statistics)
        Type: general
      – SubjectFull: MESENTERY surgery
        Type: general
    Titles:
      – TitleFull: Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury.
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              M: 10
              Text: Oct2024
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              Y: 2024
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