Faculty Collaboration Database

Implementation of a Contrast Challenge Algorithm for Adhesive Small Bowel Obstructions in Children: A Prospective, Multi-Institutional Study. Ann Surg 2025 Jun 09

Date

06/09/2025

Pubmed ID

40485473

DOI

10.1097/SLA.0000000000006775

Scopus ID

2-s2.0-105008245518 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

OBJECTIVE: Evaluate if hyperosmolar water-soluble contrast challenges (CC) can improve clinical outcomes and reduce hospital length-of-stay (LOS) in children with adhesive small bowel obstruction (ASBO).

BACKGROUND: Despite documented efficacy of CC algorithms in adults with ASBO, ongoing variability exists in management of children.

METHODS: This is a multi-institutional prospective, pre/post-algorithm implementation study of a contrast challenge algorithm in children (≤18 y) admitted with ASBO (10/2021-09/2023). Primary analysis compared patients managed in the pre-implementation phase to those in the post-implementation phase. Secondary analysis compared all patients undergoing CC to those who did not. Primary outcome was LOS. Secondary outcomes included proportion of patients receiving CC, CC-associated complications, and proportion of patients undergoing surgery. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of CC were calculated.

RESULTS: 264 patients were treated for ASBO (pre-implementation phase: n=77, adoption phase: n=80, post-implementation phase: n=107). CC use increased from 53% to 86% (pre-to-post-implementation; P<0.001). The proportion of patients undergoing surgery (35.1 vs 37.4%, P=0.747) and LOS remained similar (5.1 vs 5.6 d, P=0.802). Across all three phases, 189 patients received a CC with zero contrast-related complications. Compared to patients who did not receive CC (n=75), those receiving CC had a similar proportion undergoing surgery (42.7 vs. 33%, P=0.154) with similar LOS (5.0 vs 6.3 d, P=0.137) but significantly lower rates of readmission (2.6 vs 10.7%, P<0.001). Diagnostic performance of the CC included a sensitivity 100%, specificity 81%, NPV 100%, PPV 91%.

CONCLUSION: Contrast challenges in children are safe with excellent diagnostic performance to guide clinical decision-making.

Author List

Speck KE, Shah NR, Van Arendonk K, Rubalcava NS, Hirschl RB, Goldstein SD, Leys C, Markel TA, Rymeski B, Wright T, Matusko N, Ayala SA, Bergus KC, Carter SR, Collings A, Downard CD, Flynn-O'Brien KT, Georgeades C, Lal DR, Halaweish IF, Joshi D, Mak G, Mannava SV, Saylors SA, Trinidad S, Yeh A, Zeineddin S, Minneci PC

Authors

Katherine T. Flynn-O'Brien MD, MPH Associate Professor in the Surgery department at Medical College of Wisconsin
Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin