The American Association for the Surgery of Trauma Severity Grade is Valid and Generalizable in Adhesive Small Bowel Obstruction.

Introduction: The 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 (EAST) multi-institutional SBO prospective observational study. Methods: Adults (age>=18) with (ASBO) were included. Baseline demographics, physiologic parameters (heart rate, blood pressure, respiratory rate), labs (lactate, hemoglobin, creatinine, leukocytosis), imaging findings, operative details, length of stay, and Clavien-Dindo complications were collected. AAST ASBO grades were assigned by two independent reviewers based on imaging findings. Kappa statistic, univariate, and multivariable analyses were performed. Results: There were 635 patients with a mean (+/-SD) age of 61+/-17.8 years, 51% female, and mean BMI 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: non-operative (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

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