Pneumatosis intestinalis predictive evaluation study (PIPES): A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma

Joseph J. DuBose, Matt Lissauer, Ian Waldman, Jessica Nooralian, Steven Johnson, Adrian A. Maung, Greta L. Piper, Thomas A. O'Callaghan, Xian Luo-Owen, David Turay, Esther Wu, Kenji Inaba, Obi Okoye, Michael Esparza, Alex Shestopalov, W. Drew Fielder, Carlos Brown, Sadia Ali, Paula Ferrada, Alison WilsonJane Channel, Forrest O. Moore, Douglas B. Paul, EAST Pneumatosis Study Group

Research output: Contribution to journalReview article

29 Scopus citations

Abstract

BACKGROUND: Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life threatening. To date, series of PI outcomes consist of case reports and small retrospective series. METHODS: We conducted a retrospective multicenter study, involving eight centers, of PI from January 2001 to December 2010. De- mographics, medical history, clinical presentation, and outcomes were collected. Primary outcome was the presence of pathologic PI defined as confirmed transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression and a regression tree analysis was used to generate a clinical prediction rule for pathologic PI. RESULTS: During the 10-year study period, 500 patients with PI were identified. Of this number, 299 (60%) had benign disease, and 201 (40%) had pathologic PI. A wide variety of variables were statistically significant predictors of pathologic PI on univariate comparison. In the regression model, a lactate of 2.0 or greater was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation, and absent bowel sounds also demonstrating significance. Classification and regression tree analysis was used to create a clinical prediction rule. In this tree, the presence of a lactate value of 2.0 or greater and hypotension/vasopressor use had a predictive probability of 93.2%. CONCLUSION: Discerning the clinical significance of PI remains a challenge. We identified the independent predictors of pathologic PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted.

Original languageEnglish (US)
Pages (from-to)15-23
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1
DOIs
StatePublished - Jul 2013

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Keywords

  • Computed tomography
  • Lactate
  • Pneumatosis intestinalis

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

DuBose, J. J., Lissauer, M., Waldman, I., Nooralian, J., Johnson, S., Maung, A. A., Piper, G. L., O'Callaghan, T. A., Luo-Owen, X., Turay, D., Wu, E., Inaba, K., Okoye, O., Esparza, M., Shestopalov, A., Fielder, W. D., Brown, C., Ali, S., Ferrada, P., ... EAST Pneumatosis Study Group (2013). Pneumatosis intestinalis predictive evaluation study (PIPES): A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery, 75(1), 15-23. https://doi.org/10.1097/TA.0b013e318298486e