Background: Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a non-viable small bowel remains a challenge. Through a prospective cohort study, we aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management.

Materials and methods: All patients admitted for an acute SBO between 2004 and 2016 in our center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors.

Results: Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age ≥70 years, first episode of SBO, no bowel movement for ≥3 days, abdominal guarding, C-reactive protein (CRP) ≥50, and three abdominal Computer Tomography scanner (CT-scan) signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of >500 mL of intra-abdominal fluid. Sensitivity and specificity of this score were 65% and 88%, respectively, and the area under the curve was 0.84 (95% CI 0.80 - 0.89).

Conclusion: We developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.