Lazow Stefanie P, Tracy Sarah A, Staffa Steven J, Estroff Judy A, Parad Richard B, Castro-Aragon Ilse M, Fujii Alan M, Zurakowski David, Chen Catherine
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Am J Surg. 2021 Nov;222(5):1034-1039. doi: 10.1016/j.amjsurg.2021.04.025. Epub 2021 Apr 27.
Abdominal ultrasound (AUS) is a promising adjunct to abdominal x-ray (AXR) for evaluating necrotizing enterocolitis (NEC). We developed a multivariable risk score incorporating AUS to predict surgical NEC.
83 patients were evaluated by AXR and AUS for suspected NEC. A subset had surgical NEC. Multivariate logistic regression determined predictors of surgical NEC, which were incorporated into a risk score.
14/83 patients (16.9%) had surgical NEC. 10/83 (12.0%) patients required acute intervention, while 4/83 (4.8%) patients only required delayed surgery. Four predictors of surgical NEC were identified: abdominal wall erythema (OR: 8.2, p = 0.048), portal venous gas on AXR (OR: 29.8, p = 0.014), and echogenic free fluid (OR: 17.2, p = 0.027) and bowel wall thickening (OR: 12.5, p = 0.030) on AUS. A multivariable risk score incorporating these predictors had excellent area-under-the-curve of 0.937 (95% CI: 0.879-0.994).
AUS, as an adjunct to physical exam and AXR, has utility for predicting surgical NEC.
腹部超声（AUS）是一种很有前景的辅助腹部X线检查（AXR）来评估坏死性小肠结肠炎（NEC）的方法。我们开发了一种纳入AUS的多变量风险评分来预测手术治疗的NEC。
对83例疑似NEC患者进行了AXR和AUS评估。其中一部分患者接受了手术治疗的NEC。多变量逻辑回归确定了手术治疗NEC的预测因素，并将其纳入风险评分。
83例患者中有14例（16.9%）接受了手术治疗的NEC。83例患者中有10例（12.0%）需要紧急干预，而83例患者中有4例（4.8%）仅需要延迟手术。确定了手术治疗NEC的四个预测因素：腹壁红斑（比值比：8.2，p = 0.048）、AXR上的门静脉积气（比值比：29.8，p = 0.014）、AUS上的高回声游离液（比值比：17.2，p = 0.027）和肠壁增厚（比值比：12.5，p = 0.030）。纳入这些预测因素构建的多变量风险评分的曲线下面积为0.937，表现优异（95%置信区间：0.879 - 0.994）。
AUS作为体格检查和AXR的辅助手段，对预测手术治疗的NEC具有实用价值。
