Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：肠径阈值≥2.5cm，最初来自使用计算机断层扫描的研究，经常用于诊断小肠梗阻（SBO）与护理点超声（POCUS）。我们试图确定使用POCUS诊断SBO的最佳肠直径阈值及其预测手术干预的准确性。
方法：我们使用先前关于POCUS在5个学术ED中用于SBO诊断的系统评价的个体患者水平数据进行了二次分析。收集患者数据，包括成像结果，手术发现,最后的诊断。记录使用POCUS测量的小肠直径。构建受试者工作特征曲线（AUC）下的ROC面积，以确定预测SBO诊断和手术干预时肠直径的最佳阈值。根据性别和年龄进行亚组分析。
结果：总共403名患者有个人患者水平的数据，最终分析包括367例患者。预测SBO的最准确的总体肠径为2.75cm（AUC=0.76，95％CI0.71-0.81）。肠径≤1.7cm，敏感性为100%，无遗漏率，而≥4cm的肠径在确认SBO方面具有90.7%的特异性。65岁以下的患者的最佳阈值为2.75cm，而65岁以上的患者为2.95cm。雌性的最佳阈值为2.75厘米，而男性的值为2.95厘米。肠直径阈值与手术干预之间没有显着相关性。
结论：在POCUS上2.75cm的肠径阈值对诊断SBO更具判别性诊断准确性。患者的年龄和性别可能会影响诊断准确性，这表明可能需要量身定制的方法。
方法：我们使用先前关于POCUS在5个学术ED中用于SBO诊断的系统评价的个体患者水平数据进行了二次分析。收集患者数据，包括成像结果，手术发现,最后的诊断。记录使用POCUS测量的小肠直径。构建受试者工作特征曲线（AUC）下的ROC面积，以确定预测SBO诊断和手术干预时肠直径的最佳阈值。根据性别和年龄进行亚组分析。
结果：总共403名患者有个人患者水平的数据，最终分析包括367例患者。预测SBO的最准确的总体肠径为2.75cm（AUC=0.76，95％CI0.71-0.81）。肠径≤1.7cm，敏感性为100%，无遗漏率，而≥4cm的肠径在确认SBO方面具有90.7%的特异性。65岁以下的患者的最佳阈值为2.75cm，而65岁以上的患者为2.95cm。雌性的最佳阈值为2.75厘米，而男性的值为2.95厘米。肠直径阈值与手术干预之间没有显着相关性。
结论：在POCUS上2.75cm的肠径阈值对诊断SBO更具判别性诊断准确性。患者的年龄和性别可能会影响诊断准确性，这表明可能需要量身定制的方法。
