Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center
Abstract Background Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. Methods In this cross-sectional diagnostic study conducted from 2016 to 201...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00505-8 |
| _version_ | 1797806839273881600 |
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| author | Alexandre Nuzzo Katell Peoc’h Prabakar Vaittinada Ayar Alexy Tran-Dinh Emmanuel Weiss Yves Panis Maxime Ronot Lorenzo Garzelli Philippine Eloy Iannis Ben Abdallah Yves Castier Olivier Corcos |
| author_facet | Alexandre Nuzzo Katell Peoc’h Prabakar Vaittinada Ayar Alexy Tran-Dinh Emmanuel Weiss Yves Panis Maxime Ronot Lorenzo Garzelli Philippine Eloy Iannis Ben Abdallah Yves Castier Olivier Corcos |
| author_sort | Alexandre Nuzzo |
| collection | DOAJ |
| description | Abstract Background Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. Methods In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls). Results We included 137 patients—52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55–74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7–60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2–16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77–0.91), depending on the number of factors. Conclusions Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation. |
| first_indexed | 2024-03-13T06:13:27Z |
| format | Article |
| id | doaj.art-4a4ccace3e3a4b658c0cad8e80637ad5 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-03-13T06:13:27Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-4a4ccace3e3a4b658c0cad8e80637ad52023-06-11T11:08:57ZengBMCWorld Journal of Emergency Surgery1749-79222023-06-011811910.1186/s13017-023-00505-8Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke centerAlexandre Nuzzo0Katell Peoc’h1Prabakar Vaittinada Ayar2Alexy Tran-Dinh3Emmanuel Weiss4Yves Panis5Maxime Ronot6Lorenzo Garzelli7Philippine Eloy8Iannis Ben Abdallah9Yves Castier10Olivier Corcos11Université Paris Cité, INSERM UMR 1148Université Paris Cité, INSERM UMR 1149Emergency Department, AP-HP. Nord, Beaujon HospitalUniversité Paris Cité, INSERM UMR 1148Université Paris Cité, INSERM UMR 1149Department of Colorectal Surgery, AP-HP. Nord, Beaujon HospitalDepartment of Clinical Biochemistry, AP-HP. Nord, Beaujon HospitalDepartment of Clinical Biochemistry, AP-HP. Nord, Beaujon HospitalDepartment of Epidemiology, Biostatistics and Clinical Research, APHP. Nord, Bichat HospitalDepartment of Vascular Surgery, AP-HP. Nord, Bichat HospitalDepartment of Vascular Surgery, AP-HP. Nord, Bichat HospitalUniversité Paris Cité, INSERM UMR 1148Abstract Background Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. Methods In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls). Results We included 137 patients—52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55–74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7–60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2–16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77–0.91), depending on the number of factors. Conclusions Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.https://doi.org/10.1186/s13017-023-00505-8Intestinal ischemiaColon ischemiaIschemic colitisPeritonitis |
| spellingShingle | Alexandre Nuzzo Katell Peoc’h Prabakar Vaittinada Ayar Alexy Tran-Dinh Emmanuel Weiss Yves Panis Maxime Ronot Lorenzo Garzelli Philippine Eloy Iannis Ben Abdallah Yves Castier Olivier Corcos Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center World Journal of Emergency Surgery Intestinal ischemia Colon ischemia Ischemic colitis Peritonitis |
| title | Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center |
| title_full | Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center |
| title_fullStr | Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center |
| title_full_unstemmed | Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center |
| title_short | Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center |
| title_sort | improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen a cross sectional study from an intestinal stroke center |
| topic | Intestinal ischemia Colon ischemia Ischemic colitis Peritonitis |
| url | https://doi.org/10.1186/s13017-023-00505-8 |
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