TY - JOUR
T1 - The American Association for the Surgery of Trauma Severity Grade is valid and generalizable in adhesive small bowel obstruction
AU - Hernandez, Matthew C.
AU - Haddad, Nadeem N.
AU - Cullinane, Daniel C.
AU - Yeh, D. Dante
AU - Wydo, Salina
AU - Inaba, Kenji
AU - Duane, Therese M.
AU - Pakula, Andrea
AU - Skinner, Ruby
AU - Rodriguez, Carlos J.
AU - Dunn, Julie
AU - Sams, Valerie G.
AU - Zielinski, Martin D.
AU - Choudhry, Asad
AU - Turay, David
AU - Yune, Ji Ming
AU - Watras, Jill
AU - Widom, Kenneth A.
AU - Cull, John
AU - Toschlog, Eric A.
AU - Graybill, John C.
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - BACKGROUND: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) was validated at a single institution. We aimed to externally validate the AAST ASBO grading system using the Eastern Association for the Surgery of Trauma multi-institutional small bowel obstruction prospective observational study.METHODS: Adults (age ≥ 18) with (ASBO) were included. Baseline demographics, physiologic parameters (heart rate, blood pressure, respiratory rate), laboratory tests (lactate, hemoglobin, creatinine, leukocytosis), imaging findings, operative details, length of stay, and Clavien-Dindo complications were collected. The AAST ASBO grades were assigned by two independent reviewers based on imaging findings. Kappa statistic, univariate, and multivariable analyses were performed.RESULTS: There were 635 patients with a mean (±SD) age of 61 ± 17.8 years, 51% female, and mean body mass index was 27.5 ± 8.1. The AAST ASBO grades were: grade I (n = 386, 60.5%), grade II (n = 135, 21.2%), grade III (n = 59, 9.2%), grade IV (n = 55, 8.6%). Initial management included: nonoperative (n = 385; 61%), laparotomy (n = 200, 31.3%), laparoscopy (n = 13, 2.0%), and laparoscopy converted to laparotomy (n = 37, 5.8%). An increased median [IQR] AAST ASBO grade was associated with need for conversion to an open procedure (2 [1-3] vs. 3 [2-4], p = 0.008), small bowel resection (2 [2-2] vs. 3 [2-4], p < 0.0001), postoperative temporary abdominal closure (2 [2-3] vs. 3 [3-4], p < 0.0001), and stoma creation (2 [2-3] vs. 3 [2-4], p < 0.0001). Increasing AAST grade was associated with increased anatomic severity noted on imaging findings, longer duration of stay, need for intensive care, increased rate of complication, and higher Clavien-Dindo complication grade.CONCLUSION: The AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research focused on optimizing preoperative diagnosis and management algorithms.LEVEL OF EVIDENCE: Prognostic, level III.
AB - BACKGROUND: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) was validated at a single institution. We aimed to externally validate the AAST ASBO grading system using the Eastern Association for the Surgery of Trauma multi-institutional small bowel obstruction prospective observational study.METHODS: Adults (age ≥ 18) with (ASBO) were included. Baseline demographics, physiologic parameters (heart rate, blood pressure, respiratory rate), laboratory tests (lactate, hemoglobin, creatinine, leukocytosis), imaging findings, operative details, length of stay, and Clavien-Dindo complications were collected. The AAST ASBO grades were assigned by two independent reviewers based on imaging findings. Kappa statistic, univariate, and multivariable analyses were performed.RESULTS: There were 635 patients with a mean (±SD) age of 61 ± 17.8 years, 51% female, and mean body mass index was 27.5 ± 8.1. The AAST ASBO grades were: grade I (n = 386, 60.5%), grade II (n = 135, 21.2%), grade III (n = 59, 9.2%), grade IV (n = 55, 8.6%). Initial management included: nonoperative (n = 385; 61%), laparotomy (n = 200, 31.3%), laparoscopy (n = 13, 2.0%), and laparoscopy converted to laparotomy (n = 37, 5.8%). An increased median [IQR] AAST ASBO grade was associated with need for conversion to an open procedure (2 [1-3] vs. 3 [2-4], p = 0.008), small bowel resection (2 [2-2] vs. 3 [2-4], p < 0.0001), postoperative temporary abdominal closure (2 [2-3] vs. 3 [3-4], p < 0.0001), and stoma creation (2 [2-3] vs. 3 [2-4], p < 0.0001). Increasing AAST grade was associated with increased anatomic severity noted on imaging findings, longer duration of stay, need for intensive care, increased rate of complication, and higher Clavien-Dindo complication grade.CONCLUSION: The AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research focused on optimizing preoperative diagnosis and management algorithms.LEVEL OF EVIDENCE: Prognostic, level III.
KW - AAST
KW - SBO
KW - emergency general surgery
KW - grade
KW - severity
KW - Prognosis
KW - Prospective Studies
KW - Intestine, Small
KW - United States
KW - Humans
KW - Middle Aged
KW - Male
KW - Tissue Adhesions
KW - Traumatology
KW - Societies, Medical
KW - Time Factors
KW - Intestinal Obstruction/diagnosis
KW - Aged, 80 and over
KW - Female
KW - Aged
KW - Postoperative Complications
UR - https://www.scopus.com/pages/publications/85041568387
UR - https://www.scopus.com/pages/publications/85041568387#tab=citedBy
UR - https://www.mendeley.com/catalogue/c16a48df-887b-3be0-8ff3-15929dc0ae82/
U2 - 10.1097/TA.0000000000001736
DO - 10.1097/TA.0000000000001736
M3 - Article
C2 - 29117026
SN - 2163-0755
VL - 84
SP - 372
EP - 378
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -