Shokoohi Hamid, Al Jalbout Nour, Peksa Gary D, Mayes Katherine Dickerson, Becker Brent A, Boniface Keith S, Lahham Shadi, Secko Michael, Chavoshzadeh Miromid, Jang Timothy, Gottlieb Michael
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Rush University Medical Center, Chicago, IL, United States of America.
Am J Emerg Med. 2024 Oct;84:1-6. doi: 10.1016/j.ajem.2024.07.019. Epub 2024 Jul 14.
A bowel diameter threshold of ≥2.5 cm, originally derived from the research using computed tomography, is frequently used for diagnosing small bowel obstruction (SBO) with point-of-care ultrasound (POCUS). We sought to determine the optimal bowel diameter threshold for diagnosing SBO using POCUS and its accuracy in predicting surgical intervention.
We conducted a secondary analysis using individual patient-level data from a previous systematic review on POCUS for SBO diagnosis across five academic EDs. Patient data were collected, including imaging results, surgical findings, and final diagnosis. The measured diameter of the small bowel using POCUS was recorded. ROC area under the receiver operating characteristic curves (AUC) were constructed to determine the optimal threshold for bowel diameter in predicting SBO diagnosis and surgical intervention. Subgroup analyses were performed based on sex and age.
A total of 403 patients had individual patient-level data available, with 367 patients included in the final analysis. The most accurate bowel diameter overall for predicting SBO was 2.75 cm (AUC = 0.76, 95% CI 0.71-0.81). A bowel diameter of ≤1.7 cm had 100% sensitivity with no miss rate, while a bowel diameter of ≥4 cm had 90.7% specificity in confirming SBO. Patients under 65 had an optimal threshold of 2.75 cm versus 2.95 cm in patients over 65. Females had an optimal threshold of 2.75 cm, while males had a value of 2.95 cm. There was no significant correlation between bowel diameter thresholds and surgical intervention.
A bowel diameter threshold of 2.75 cm on POCUS is more discriminative diagnostic accuracy for diagnosing SBO. Patients' age and sex may impact diagnostic accuracy, suggesting that tailored approaches may be needed.
肠径阈值≥2.5 cm最初源自计算机断层扫描研究，目前常用于床旁超声（POCUS）诊断小肠梗阻（SBO）。我们试图确定使用POCUS诊断SBO的最佳肠径阈值及其预测手术干预的准确性。
我们使用来自之前一项关于在五个学术急诊科使用POCUS诊断SBO的系统评价中的个体患者水平数据进行了二次分析。收集了患者数据，包括影像学结果、手术发现和最终诊断。记录使用POCUS测量的小肠直径。构建受试者操作特征曲线（ROC）下的面积（AUC）以确定预测SBO诊断和手术干预的肠径最佳阈值。根据性别和年龄进行亚组分析。
共有403例患者有个体患者水平数据，最终分析纳入367例患者。预测SBO的总体最准确肠径为2.75 cm（AUC = 0.76，95% CI 0.71 - 0.81）。肠径≤1.7 cm时敏感性为100%，无漏诊率，而肠径≥4 cm时确诊SBO的特异性为90.7%。65岁以下患者的最佳阈值为2.75 cm，65岁以上患者为2.95 cm。女性的最佳阈值为2.75 cm，男性为2.95 cm。肠径阈值与手术干预之间无显著相关性。
POCUS测量的肠径阈值为2.75 cm时对诊断SBO具有更高的鉴别诊断准确性。患者的年龄和性别可能影响诊断准确性，提示可能需要采用个性化方法。
