• Matthew C Hernandez, Nadeem N Haddad, Daniel C Cullinane, D Dante Yeh, Salina Wydo, Kenji Inaba, Therese M Duane, Andrea Pakula, Ruby Skinner, Carlos J Rodriguez, Julie Dunn, Valerie G Sams, Martin D Zielinski, Asad Choudhry, David Turay, Ji-Ming Yune, Jill Watras, Kenneth A Widom, John Cull, Eric A Toschlog, John C Graybill, and EAST SBO Workgroup.
• From the Division of Trauma Critical Care and General Surgery, Department of Surgery (M.C.H., N.N.H., M.D.Z., A.C.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (D.C.C.), Marshfield Clinic, Marshfield, Wisconsin; Division of Trauma, Department of Surgery (D.T., J-M.Y.), Loma Linda University, Loma Linda, California; Division of Trauma Surgery, Department of Surgery (S.W.), Cooper University Hospital, New Jersey; Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Department of Surgery (D.D.Y.), Massachusetts General Hospital, Boston, Massachusetts; Division of Trauma Surgery, Department of Surgery (T.M.D.), John Peter Smith, Fort Worth, Texas; Department of Surgery (A.P.), Kern Medical Center, Baekrsfield, California; Division of Trauma, Department of Surgery (J.W.), Inova Fairfax Hospital, Annandale, Virginia; Division of Trauma, Department of Surgery (C.J.R.), Water Reed National Military Medical Center, Bethesda, Maryland; Department of Surgery (K.A.W.), Geisinger Medical Center, Danville, Pennsylvania; Department of Surgery (J.C.), Greenville Memorial Hospital, Greenville, South Carolina; Department of Surgery (J.D.), UC Health Northern Colorado, Fort Collins, Colorado; Department of Surgery (E.A.T.), East Carolina University, Greenville, North Carolina; and Department of Surgery (J.C.G.), San Antonio Military Medical Center, San Antonio, Texas.
• J Trauma Acute Care Surg. 2018 Feb 1; 84 (2): 372-378.

BackgroundThe American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) was validated at a single institution. We aimed to externally validate the AAST ASBO grading system using the Eastern Association for the Surgery of Trauma multi-institutional small bowel obstruction prospective observational study.MethodsAdults (age ≥ 18) with (ASBO) were included. Baseline demographics, physiologic parameters (heart rate, blood pressure, respiratory rate), laboratory tests (lactate, hemoglobin, creatinine, leukocytosis), imaging findings, operative details, length of stay, and Clavien-Dindo complications were collected. The AAST ASBO grades were assigned by two independent reviewers based on imaging findings. Kappa statistic, univariate, and multivariable analyses were performed.ResultsThere were 635 patients with a mean (±SD) age of 61 ± 17.8 years, 51% female, and mean body mass index was 27.5 ± 8.1. The AAST ASBO grades were: grade I (n = 386, 60.5%), grade II (n = 135, 21.2%), grade III (n = 59, 9.2%), grade IV (n = 55, 8.6%). Initial management included: nonoperative (n = 385; 61%), laparotomy (n = 200, 31.3%), laparoscopy (n = 13, 2.0%), and laparoscopy converted to laparotomy (n = 37, 5.8%). An increased median [IQR] AAST ASBO grade was associated with need for conversion to an open procedure (2 [1-3] vs. 3 [2-4], p = 0.008), small bowel resection (2 [2-2] vs. 3 [2-4], p < 0.0001), postoperative temporary abdominal closure (2 [2-3] vs. 3 [3-4], p < 0.0001), and stoma creation (2 [2-3] vs. 3 [2-4], p < 0.0001). Increasing AAST grade was associated with increased anatomic severity noted on imaging findings, longer duration of stay, need for intensive care, increased rate of complication, and higher Clavien-Dindo complication grade.ConclusionThe AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research focused on optimizing preoperative diagnosis and management algorithms.Level Of EvidencePrognostic, level III.

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