Maaret Eskelinen1, Jannica Meklin1, Kari Syrjänen2,3, Matti Eskelinen4. 1. Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland. 2. Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil. 3. SMW Consultants, Ltd., Kaarina, Finland. 4. Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland; matti.eskelinen@kuh.fi.
Abstract
BACKGROUND/AIM: The diagnosis of acute small bowel obstruction (ASBO) may be difficult and the decision to operate is based on clinical findings. So far, the diagnostic scores (DSs) for ASBO detection have been rarely evaluated. PATIENTS AND METHODS: A cohort of 1,333 acute abdominal pain (AAP) patients with 54 ASBO patients, were included in the study. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for ASBO diagnosis with location of pain at diagnosis (LP+) and without location of pain at diagnosis (LP-). Meta-analytical techniques were used to calculate the summary sensitivity (Se) and specificity (Sp) estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) clinical history-taking, ii) diagnostic findings and tests, iii) DSLP- and iv) DSLP+ were as follows: i) AUC=0.638 (95%CI=0.600-0.676); ii) AUC=0.694 (95%CI=0.630-0.724), iii) AUC=0.962 (95%CI=0.940-0.986), and for iv) AUC=0.971 (95%CI=0.952-0.988). In roccomp analysis for the AUC values, the differences are significant as follows: between i) and ii) p=0.312; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.317. CONCLUSION: The present study is the first to provide data that the DS could be used for clinical diagnosis of ASBO without radiological or laboratory analyses, to reach a high diagnostic accuracy in AAP patients.
BACKGROUND/AIM: The diagnosis of acute small bowel obstruction (ASBO) may be difficult and the decision to operate is based on clinical findings. So far, the diagnostic scores (DSs) for ASBO detection have been rarely evaluated. PATIENTS AND METHODS: A cohort of 1,333 acute abdominal pain (AAP) patients with 54 ASBO patients, were included in the study. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for ASBO diagnosis with location of pain at diagnosis (LP+) and without location of pain at diagnosis (LP-). Meta-analytical techniques were used to calculate the summary sensitivity (Se) and specificity (Sp) estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) clinical history-taking, ii) diagnostic findings and tests, iii) DSLP- and iv) DSLP+ were as follows: i) AUC=0.638 (95%CI=0.600-0.676); ii) AUC=0.694 (95%CI=0.630-0.724), iii) AUC=0.962 (95%CI=0.940-0.986), and for iv) AUC=0.971 (95%CI=0.952-0.988). In roccomp analysis for the AUC values, the differences are significant as follows: between i) and ii) p=0.312; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.317. CONCLUSION: The present study is the first to provide data that the DS could be used for clinical diagnosis of ASBO without radiological or laboratory analyses, to reach a high diagnostic accuracy in AAP patients.