Clinical and Laboratory Variables Related to Small Bowel Obstruction in Crohnʼs Disease
Bibliographic record
Abstract
Purpose: Small bowel obstruction (SBO) in Crohn's disease (CD) results from disease exacerbation or adhesions from previous surgery (OR). Management may require OR or Medical (Con) therapy (Rx). We evaluated clinical and laboratory variables in patients who presented to the emergency with SBO and compared them with or without CD to aid decisions about Rx. Methods: Charts of 205 patients (147 CD, 58 NonCD) with SBO for a 5-year period were reviewed. Four groups were identified: CD OR (N81), CD Con (N66), NonCD OR (N31) and NonCD Con (N27). Variables abstracted were sex, age, ethnicity, smoking, alcohol, previous OR, duration of CD (< or > 10yr), previous medical Rx, temperature, pulse, abdominal tenderness, signs of perforation, results of abdominal X-ray, CT abd, Hgb, MCV,WBC, PMNL, lymph, platelets, MPV, iron levels, and albumin. Three broad questions were analyzed: (1) Any distinguishing markers of CD (censoring history and imaging) vs. NonCD; (2) Any distinguishing features pre-OR for OR vs. Con therapy within CD and NonCD; and (3) In CD, any features pre-OR favoring findings of CD or Adhesions (A). ANOVA, chi-square and exact tests were utilized. Results: 1) The following variables were significant for CD (p<0.001): age<50 (72% vs. 22%), smoking history (68% vs. 14%) and low MPV (8.4±1.3 vs. 10.2±1.5). Modest increase of WBC favoured NonCD (11.6±4.5 vs. 9.6±4.0, p=0.002). 2) The following were associated with surgical treatment: In CD (p<0.001), smoking (96% vs. 32%), previous medical Rx (70% vs. 29%), temperature (38.1±0.4 vs. 36.8±0.8), pulse (104±15 vs. 79±9), positive abdominal CT (90% vs. 41%), and CD duration >10 years (63% vs. 46%, p=0.046); In NonCD (p<0.001), history of previous OR (100% vs. 37%), temperature (38.2±0.4 vs. 36.5±0.7), pulse (102±12 vs. 75±10) and elevated WBC (15.0±2.3 vs. 7.8±3.1). 3) In the CD OR group, only 2 variables were significant. Jewish ethnicity favoured finding CD (56% vs. 33%, p=0.03) and history of previous surgery favoured adhesions (94% vs. 2%, p<0.001). Preoperative perforation, abdominal examination, abdominal X-rays and CT abd were non-distinguishing. Conclusion: While clinical judgement remains the main tool for decisions, several parameters may help in management of SBO. A young smoker with low MPV should raise suspicion of CD in naive patients. In CD patients, smoking, previous medical Rx, perhaps long standing CD and a positive CT abd may portend a higher likelihood to intervene surgically. A toxic patient with or without CD may also be at higher risk. In CD patients there are no obvious pre-OR features which reliably predict OR findings. The conclusions need to be validated in a prospective cohort.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".