Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): A Multicenter epidemiologic study of the American Association for the Surgery of Trauma.

Background: Our group has previously published a retrospective review defining variables predictive of transmural bowel ischemia in the setting of Pneumatosis Intestinalis (PI). We hypothesize this prospective study will confirm the findings of the retrospective review, enhancing legitimacy to the predictive factors for pathological PI previously highlighted. Methods: Data was collected using the Research Electronic Data Capture. Forward logistic regression was utilized to identify independent predictors for pathologic PI. Statistical significance was defined as a p-value of 2.0, were predictive of pathological PI as well as clinical factors including adynamic ileus, peritoneal signs on physical exam, sepsis, and hypotension. The Location was also a significant factor, as patients with small bowel PI had a higher incidence of transmural ischemia than colonic PI. On multiple logistic regression, lactate value of > 2.0 [OR 5.1, 1.3-19.5, p=0.018], elevated INR [OR 3.2, 1.1-9.6, p=0.031], peritonitis [15.0, 2.9-78, p=0.001], and decreased hemoglobin [0.70, 0.50-0.97, 0.031] remained significant predictors of transmural ischemia [AUC 0.90, 0.83-0.97]. A lactate value of 2.0 or greater and peritonitis are common factors between the retrospective review and this prospective study. Conclusion: We recommend surgical exploration to be strongly considered for those PI patients presenting also with a lactate>2 or/and peritonitis. We suggest strong suspicion for necrosis in those patient with PI and small bowel involvement, ascites on CT scan, adynamic ileus, anemia and a high INR. Level of Evidence: Prognostic and Epidemiological level I Disclosure: None (C) 2016 Lippincott Williams & Wilkins, Inc.

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