Through the use of clinical data, blood test results, and computed tomography (CT) findings, researchers for a study attempted to develop a diagnostic model of closed-loop small bowel obstruction (CL-SBO).
The pertinent preoperative data of all patients with small bowel obstruction (SBO) who had surgery at the Qingdao university associated hospital between January 1, 2018, and October 31, 2021, was evaluated. To create a diagnostic nomogram model, all variables were chosen using univariate analysis and backward stepwise regression. Data from Qingdao Central Hospital were utilized for external validation, while K-fold cross-validation and bootstrap resampling techniques were employed for internal validation. In the closed-loop small bowel obstruction (CL-SBO) group, they also carried out subgroup analyses based on intestinal ischemia and assessed the diagnostic performance of each CT result.
A total of 219 patients (95 in the CL-SBO group and 124 in the open-loop small bowel obstruction [OL-SBO] group) participated in the study. D-dimers were chosen as the prognostic factors of the nomogram (median 1,085 vs. 690, P = 0.019), ascites (71.6% vs. 53.2%, P = 0.006), tenderness (77.9% vs. 59.7%, P = 0.004), more than one beak sign (65.3% vs. 30.6%, P< 0.001), radial distribution (18.9% vs. 6.5%, P = 0.005), whirl sign (35.8% vs. 8.9%, P < 0.001). The Brier score was 0.182, and Harrell’s C statistic for this model was 0.786 (95% CI, 0.724-0.848). The external validation Harrell’s C statistic was 0.784 (95% CI, 0.664-0.905); the Brier score was 0.190. Radial distribution, U/C-shaped loop, and whirl sign demonstrated great specificity (93.5%, 96.0%, and 91.1%, respectively) but low sensitivity (18.9%, 8.4%, and 35.8%, respectively) in relation to the CT results. D-dimer concentrations and discomfort were linked to bowel ischemia.
When patients have a high chance of developing CL-SBO, surgery should be taken into consideration. The nomogram accurately predicted CL-SBO in patients with SBO.
Reference: sciencedirect.com/science/article/pii/S0735675722006568
