Schwenter et al developed a Clinicoradiologic Score (CRS) for identifying a patient with strangulated small bowel obstruction (SBO). The authors are from Geneva University in Switzerland.
Patient selection: small bowel obstruction
Outcome: identification of a patient who has developed intestinal ischemia
Parameters:
(1) number of days with abdominal pain
(2) guarding on physical examination
(3) C-reactive protein (CRP) concentration in mg/L
(4) white blood cell count in 10^9/L
(5) free intraperitoneal fluid volume in mL on the abdominal CT scan
(6) contrast enhancement of small bowel wall on the abdominal CT scan
|
Parameter
|
Finding
|
Points
|
|
number of days with abdominal pain
|
0 to 3
|
0
|
|
|
4 or more
|
1
|
|
guarding on physical exam
|
absent
|
0
|
|
|
present
|
1
|
|
CRP concentration
|
< 75 mg/dL
|
0
|
|
|
>= 75 mg/L
|
1
|
|
white blood cell count
|
< 10 * 10^9/L
|
0
|
|
|
>= 10 * 10^9/L
|
1
|
|
free intraperitoneal fluid
|
< 500 mL
|
0
|
|
|
>= 500 mL
|
1
|
|
contrast enhancement
|
not reduced
|
0
|
|
|
reduced
|
1
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the more likely surgery will be performed.
• About 75% of patients with a score >= 3 underwent small bowel resection.
• A score <= 1 had a risk for intestinal ischemia of about 6%.
Performance:
• A score >= 3 was 68% sensitive and 91% specific, with an AUC ROC curve 0.87.
