Category: Trauma
Keywords: blunt bowel injury, BIPS, prediction, blunt trauma (PubMed Search)
Posted: 9/6/2024 by Robert Flint, MD
(Updated: 9/8/2024)
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Predicting which blunt abdominal trauma patients have mesenteric or bowel wall injuries early in their ED course will decrease morbidity and mortality. It is also a challenge even in the age of advanced CT imaging. This study from India looks at the Bowel Injury Prediction Score as a possible means to catch these injuries early in the course of care. The score uses white blood cell count over 17,000 (1 point), abdominal tenderness at the time of presentation(1 point), as well as a McNutt's scoring scale grade 4 (1 point) (table). The study found those with a score greater than 2 (out of 0-3) were much more likely to have bowel or mesenteric injury at time of laparotomy. Tenderness and CT findings were more likely to be predictive of bowel injury than WBC greater than 17,000. “BIPS had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI.”
My take away is an abnormal CT scan or significant tenderness of presentation warrant concern for mesenteric or bowel wall injury and surgical evaluation is appropriate for these patients. An elevated or normal white blood cell count isn't helpful in these patients. Surgeons may use this scale to help them decide if a patient warrants a trip to the operating room
| GRADE | FINDING |
|---|---|
| 1 | Isolated mesenteric contusion without associated bowel wall thickening or adjacent interloop fluid collection |
| 2 | Mesenteric hematoma?<?5 cm without associated bowel wall thickening or adjacent interloop fluid collection |
| 3 | Mesenteric hematoma?>?5 cm without associated bowel wall thickening or adjacent interloop fluid collection |
| 4 | Mesenteric contusion or hematoma (any size) with associated bowel wall thickening or adjacent interloop fluid collection |
| 5 | Active vascular or oral contrast extravasation bowel transaction or pneumoperitoneum |
Gupta SK, Singh PK, Sharma S, Gupta SK. Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury. Trauma. 2023;0(0). doi:10.1177/14604086231187523
