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Introduction
Small bowel obstructions (SBOs) are a common cause of abdominal surgery, 1 but are difficult to diagnose as they can mimic other causes of abdominal pain. 2 Classically, patients with SBOs present with nausea/vomiting, abdominal distension and pain, and constipation/obstipation with variable exam findings. 3 The Eastern Association for the Surgery of Trauma SBO guidelines utilise physical exam findings to determine operative management 4 and the diagnosis of SBO is often made by history and physical exam with plain abdominal radiography, 5 but others have questioned the accuracy of history and physical exam for diagnosing and managing SBO. 6 7 The purpose of this study was to determine the predictive value of various signs and symptoms for SBO in patients with prior abdominal surgery.
Methods
Study design
This was a secondary analysis of a previously reported prospective study of bedside ultrasonography (BUS) for SBO. 8 A convenience sample of patients with suspected SBO underwent BUS followed by CT to assess the accuracy of BUS for SBO. For the current study, charts were further reviewed to determine the predictive values of various signs and symptoms for SBO in patients with prior abdominal surgery, as it was expected that these parameters would perform best for this higher risk population where accurate diagnosis can be especially challenging.
Study setting
This study was conducted at an urban, academic ED with 49 000 annual adult visits and an emergency medicine training programme.
Selection of participants
In the primary study, patients were eligible for enrolment if a study physician was available to perform BUS for SBO prior to CT. BUS exams were performed by physicians who completed a didactic session and demonstrated competency with five exams for SBO before enrolling patients.
Protocol
Charts from the initial study were reviewed for patients with prior abdominal surgery. The presenting signs and symptoms were then compared to the diagnosis of SBO. The absence of...