UCLA Department of Medicine, 757 Westwood Blvd, Los Angeles, CA, 90095, USA.
New York University Department of Radiology, 550 First Ave, New York, NY, 10016, USA.
Abdom Radiol (NY). 2020 Sep;45(9):2663-2668. doi: 10.1007/s00261-020-02514-6.
For more than half of Crohn's disease patients, strictures will cause bowel obstructions that require surgery within 10 years of their initial diagnosis. This study utilizes computed tomography imaging and clinical data obtained at the initial emergency room visit to create a prediction model for progression to surgery in Crohn's disease patients with acute small bowel obstructions.
A retrospective chart review was performed for patients who presented to the emergency room with an ICD-10 diagnosis for Crohn's disease and visit diagnosis of small bowel obstruction. Two expert abdominal radiologists evaluated the CT scans for bowel wall thickness, maximal and minimal luminal diameters, length of diseased segment, passage of oral contrast, evidence of penetrating disease, bowel wall hyperenhancement or stratification, presence of a comb sign, fat hypertrophy, and small bowel feces sign. The primary outcome was progression to surgery within 6 months of presentation. The secondary outcome was time to readmission.
Forty patients met the inclusion criteria, with 78% receiving medical treatment alone and 22% undergoing surgery within 6 months of presentation to the emergency room. Multivariable analysis produced a model with an AUC of 92% (95% CI 0.82-1.00), 78% sensitivity, and 97% specificity, using gender, body mass index, and the radiographic features of segment length, penetrating disease, and bowel wall hyperenhancement.
The model demonstrates that routine clinical and radiographic data from an emergency room visit can predict progression to surgery, and has the potential to risk stratify patients, guide management in the acute setting, and predict readmission.
在克罗恩病患者中，有一半以上的患者会在确诊后 10 年内因狭窄导致肠阻塞而需要手术。本研究利用计算机断层扫描成像和初始急诊就诊时获得的临床数据，为急性小肠阻塞的克罗恩病患者建立一个预测手术进展的模型。
对因 ICD-10 克罗恩病诊断和就诊诊断为小肠梗阻而到急诊就诊的患者进行回顾性病历审查。两位腹部放射学专家评估 CT 扫描的肠壁厚度、最大和最小管腔直径、病变节段长度、口服造影剂通过情况、穿透性疾病证据、肠壁强化或分层、梳征、脂肪肥厚和小肠粪便征的存在。主要结局是在就诊后 6 个月内进展为手术。次要结局是再次入院时间。
40 名患者符合纳入标准，78%仅接受药物治疗，22%在就诊后 6 个月内接受手术。多变量分析产生了一个 AUC 为 92%（95%CI 0.82-1.00）、78%的敏感性和 97%特异性的模型，使用性别、体重指数以及节段长度、穿透性疾病和肠壁强化的放射学特征。
该模型表明，急诊就诊时的常规临床和放射学数据可以预测手术进展，并有潜力对患者进行风险分层，指导急性处理，预测再次入院。
