TY - JOUR
T1 - Pneumatosis intestinalis predictive evaluation study (PIPES)
T2 - A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma
AU - DuBose, Joseph J.
AU - Lissauer, Matt
AU - Waldman, Ian
AU - Nooralian, Jessica
AU - Johnson, Steven
AU - Maung, Adrian A.
AU - Piper, Greta L.
AU - O'Callaghan, Thomas A.
AU - Luo-Owen, Xian
AU - Turay, David
AU - Wu, Esther
AU - Inaba, Kenji
AU - Okoye, Obi
AU - Esparza, Michael
AU - Shestopalov, Alex
AU - Fielder, W. Drew
AU - Brown, Carlos
AU - Ali, Sadia
AU - Ferrada, Paula
AU - Wilson, Alison
AU - Channel, Jane
AU - Moore, Forrest O.
AU - Paul, Douglas B.
AU - EAST Pneumatosis Study Group
PY - 2013/7
Y1 - 2013/7
N2 - BACKGROUND: Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life threatening. To date, series of PI outcomes consist of case reports and small retrospective series. METHODS: We conducted a retrospective multicenter study, involving eight centers, of PI from January 2001 to December 2010. De- mographics, medical history, clinical presentation, and outcomes were collected. Primary outcome was the presence of pathologic PI defined as confirmed transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression and a regression tree analysis was used to generate a clinical prediction rule for pathologic PI. RESULTS: During the 10-year study period, 500 patients with PI were identified. Of this number, 299 (60%) had benign disease, and 201 (40%) had pathologic PI. A wide variety of variables were statistically significant predictors of pathologic PI on univariate comparison. In the regression model, a lactate of 2.0 or greater was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation, and absent bowel sounds also demonstrating significance. Classification and regression tree analysis was used to create a clinical prediction rule. In this tree, the presence of a lactate value of 2.0 or greater and hypotension/vasopressor use had a predictive probability of 93.2%. CONCLUSION: Discerning the clinical significance of PI remains a challenge. We identified the independent predictors of pathologic PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted.
AB - BACKGROUND: Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life threatening. To date, series of PI outcomes consist of case reports and small retrospective series. METHODS: We conducted a retrospective multicenter study, involving eight centers, of PI from January 2001 to December 2010. De- mographics, medical history, clinical presentation, and outcomes were collected. Primary outcome was the presence of pathologic PI defined as confirmed transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression and a regression tree analysis was used to generate a clinical prediction rule for pathologic PI. RESULTS: During the 10-year study period, 500 patients with PI were identified. Of this number, 299 (60%) had benign disease, and 201 (40%) had pathologic PI. A wide variety of variables were statistically significant predictors of pathologic PI on univariate comparison. In the regression model, a lactate of 2.0 or greater was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation, and absent bowel sounds also demonstrating significance. Classification and regression tree analysis was used to create a clinical prediction rule. In this tree, the presence of a lactate value of 2.0 or greater and hypotension/vasopressor use had a predictive probability of 93.2%. CONCLUSION: Discerning the clinical significance of PI remains a challenge. We identified the independent predictors of pathologic PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted.
KW - Computed tomography
KW - Lactate
KW - Pneumatosis intestinalis
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UR - http://www.scopus.com/inward/citedby.url?scp=84880263177&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e318298486e
DO - 10.1097/TA.0b013e318298486e
M3 - Review article
C2 - 23778433
SN - 2163-0755
VL - 75
SP - 15
EP - 23
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -