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The following is a summary of “Optimal bowel diameter thresholds for diagnosing small bowel obstruction and surgical intervention with point-of-care ultrasound,” published in the October 2024 issue of Emergency Medicine by Shokoohi et al. 

The research using computed tomography established a bowel diameter threshold of ≥2.5 cm for detecting small bowel obstruction (SBO) with point-of-care ultrasound (POCUS).   

Researchers conducted a retrospective study to specify the optimal bowel diameter threshold for diagnosing SBO using POCUS and its accuracy in predicting surgical intervention.  

They analyzed individual patient data from a previous systematic review on POCUS for SBO diagnosis across 5 academic EDs. The data on imaging results, surgical findings, and final diagnosis were collected, and the small bowel diameter was recorded by POCUS, ROC curves under the receiver operating characteristic curves (AUC) were used to determine the optimal bowel diameter threshold for predicting SBO diagnosis and surgical intervention while subgroup analyses were conducted based on sex and age.  

The results showed 403 patients had individual patient-level data available, with 367 patients included in the final analysis. The most accurate bowel diameter 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 vs 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, with no substantial correlation between bowel diameter thresholds and surgical intervention.  

Investigators concluded that a bowel diameter threshold of 2.75 cm on POCUS is more discriminative diagnostic accuracy for diagnosing SBO, impacting the accuracy of the patient’s age and sex. 

Source: sciencedirect.com/science/article/abs/pii/S0735675724003346