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A Novel Scoring System for Diagnosing Acute Mesenteric Ischemia in the Emergency Ward

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Abstract

Background

Early diagnosis of acute mesenteric ischemia (AMI) based on clinical judgment has been proved to be too difficult. Therefore, it is important for identifying clinical parameters that can differentiate AMI from other acute abdomen upon presentation.

Methods

We analyzed a database of 106 consecutive patients admitted to the emergency ward for suspected AMI in whom diagnosis of AMI was confirmed by laparotomy, CT angiography or mesenteric angiography. The patients’ demographics, previous history, clinical signs, results of laboratory investigations and ultrasonography were collected. Diagnostic cutoff value of quantitative indexes was derived from the receiver operating curve. Multivariate logistic regression was used to identify risk factors for AMI and formulated these risk factors into a scoring system.

Results

A total of 45 patients (42.5%) were confirmed to have AMI. Compared with other acute abdomen, AMI had significantly increased level of white blood cell (Odds ratio (OR) 16.11, 95% confidence interval (CI) 1.10–235.34), red cell distribution width (OR 27.65, 95% CI 1.53–501.02), mean platelet volume (OR 16.06, 95% CI 1.48–174.50) and D-dimer (OR 42.91, 95% CI 2.56–718.09). A diagnostic score was calculated by adding points assigned to the four parameters, and a cutoff score of four best identified patients with AMI, with sensitivity, specificity, positive and negative predictive values of 97.8, 91.8, 89.8 and 98.2%, respectively.

Conclusion

This scoring system based on easily available parameters could be used as a useful tool for differentiating AMI from other acute abdomen in the emergency ward. Prospective studies with large sample remain needed for validating the results.

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Acknowledgements

The study was supported by Youth Foundation of Guangxi Medical University (No. GXMUYSF201506 and GXMUYSF201502) and the National Natural Science Foundation of China (No. 81360370).

Author's contributions

ZW and JQC contributed equally to this article; ZW, JQC, JLL and LT designed this study; ZW and JLL collected the data; ZW and JQC analyzed the data; JQC and LT interpreted the results; ZW drafted the article; JQC and LT revised the paper.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China

    Zhen Wang, Jun-Qiang Chen, Jin-lu Liu & Lei Tian

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  1. Zhen Wang
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  2. Jun-Qiang Chen
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  3. Jin-lu Liu
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  4. Lei Tian
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Correspondence to Zhen Wang or Jun-Qiang Chen.

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Wang, Z., Chen, JQ., Liu, Jl. et al. A Novel Scoring System for Diagnosing Acute Mesenteric Ischemia in the Emergency Ward. World J Surg 41, 1966–1974 (2017). https://doi.org/10.1007/s00268-017-3984-9

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  • DOI: https://doi.org/10.1007/s00268-017-3984-9

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