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Likelihood Ratio (LR) in Emergency Medicine


Run to the operation room!

Clinical Scenario

A 70 yo woman is brought to the ED by ambulance.
She’s suffering from vomit, lach of flatus and abdominal pain since 24 hours says the nurse. 
She’s pale, the abdomen shows a midline scar. There is diffused tenderness with rebound.
Abdomen US and X rays show abnormal distended loop of small bowel.

Ok, Ok I saw the images, there’s an occlusion says the surgeon at phone but, you know, I need a CT!

Are there CT findings that identify patients requiring a run to the operation room? 


Fortunately more than half of patients who present with SBO, resolves with non operative therapy. But on the other hand, more than 50% of bowel obstructions with ischemia are misdiagnosed. 
When all 3 Zielinski's signs are present strong consideration of early operative exploration should be take into account. 


MD Zielinski
J Am Coll Surg 2011 212 1068-1076 

CS Santillan
Radiol Clin N Am 2013 51 17-27

Ciro Paolillo


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