Multi-center validation of the Bowel Injury Predictive Score (BIPS) for the early identification of need to operate in blunt bowel and mesenteric injuries |
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| Institution: | 1. McGovern Medical School at UT Health, 6410 Fannin St, Houston, TX 77030, USA;2. University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA;3. University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA;4. Oklahoma University Health Science Center, 865 Research Pkwy, Oklahoma, OK 73104, USA;5. Denver Health Medical Center, 777 Bannock St, Denver, CO 80204, USA;6. Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA;8. Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, San Diego, CA 92037, USA;9. UC Health Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538, USA;10. Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA;11. University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA;12. Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA;13. Virginia Commonwealth University Medical Center, 1204 E Marshal St #4-100, Richmond, VA 23298, USA;14. UCHealth Memorial Hospital Central, 1400 E Boulder St, Colorado Springs, CO 80909, USA;15. University of Michigan, 1301 Catherine St, Ann Arbor, MI 48109, USA;1. Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark;2. The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;3. Trauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark;1. University of Kentucky, College of Medicine, Lexington, KY, USA;2. Department of Surgery, Division of Health Outcomes and Optimal Services, University of Kentucky, Lexington, KY, USA;3. Department of Surgery, Division of Acute Care Surgery, Trauma, and Surgical Critical Care, University of Kentucky College of Medicine and UK Healthcare, 800 Rose Street, C207, Lexington, KY 40536-0298, USA;1. Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia;2. Department of Surgery, Monash University Central Clinical School, Australia;3. Department of Respiratory medicine, Allergy, asthma and Clinical Immunology, Alfred Hospital, Melbourne, Victoria, Australia;4. National Trauma Research Institute, Monash University Central Clinical School, Melbourne, Australia;1. Washington University in St. Louis, Department of Biomedical Engineering, USA;2. University of Michigan Medical School, USA;3. Michigan Center for Global Surgery, USA;4. Washington University in St. Louis, Department of Psychological and Brain Sciences, USA;5. University of Michigan Department of Surgery, Division of Acute Care Surgery, USA;6. University of Alabama at Birmingham, School of Public Health, Department of Healthcare Organization and Policy, USA;1. Professor of Surgery, Hackensack Meridian School of Medicine. Chief of Trauma & Medical Director of Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA;2. Department of Research Administration, Jersey Shore University Medical Center, Neptune, NJ, USA |
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| Abstract: | IntroductionThe Bowel Injury Prediction Score (BIPS) is a tool for identifying patients at risk for blunt bowel and mesenteric injury (BBMI) requiring surgery. BIPS is calculated by assigning one point for each of the following: (1) WBC ≥ 17,000, (2) abdominal tenderness, and (3) injury grade ≥ 4 (mesenteric contusion or hematoma with bowel wall thickening or adjacent interloop fluid collection) on CT scan. A total score ≥ 2 is associated with BBMI requiring surgery. We aimed to validate the BIPS as a predictor for patients with BBMIs requiring operative intervention in a multi-center prospective study.Materials and methodsPatients were prospectively enrolled at 15 U.S. trauma centers following blunt trauma with suspicion of BBMI on CT scan between July 1, 2018 and July 31, 2019. The BIPS was calculated for each patient enrolled in the study.ResultsOf 313 patients, 38% had BBMI requiring operative intervention. Patients were significantly more likely to require surgery in the presence of abdominal tenderness (OR, 3.6; 95% CI, 1.6–8.0) and CT grade ≥ 4 (OR, 11.7; 95% CI, 5.7–23.7). Patients with a BIPS ≥ 2 were more than ten times more likely to require laparotomy than those with a BIPS < 2 (OR, 10.1; 95% CI, 5.0–20.4). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a BIPS ≥ 2 for BBMI requiring surgery was 72% (CI 0.6–0.8), 78% (CI 0.7–0.8), 67% (CI 0.6–0.8), and 82% (CI 0.8–0.9), respectively. The AUROC curve for BIPS ≥ 2 was 0.75. The sensitivity, specificity, PPV, and NPV of a BIPS ≥ 2 for BBMI requiring surgery in patients with severe alteration in mental status (GCS 3–8) was 70% (CI 0.5–0.9), 92% (CI 0.8–1.0), 82% (CI 0.6–1.0), and 86% (CI 0.7–1.0), respectively.ConclusionThis prospective multi-center trial validates BIPS as a predictor of BBMI requiring surgery. Calculation of BIPS during the initial evaluation of trauma patients is a useful adjunct to help general surgeons taking trauma call determine operative versus non-operative management of patients with BBMI including those with severe alteration in mental status. |
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