Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls). We included 137 patients—52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55–74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7–60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2–16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77–0.91), depending on the number of factors. Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.

中文翻译：

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Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center,改善急腹症患者急性肠系膜缺血的临床怀疑：来自肠道卒中中心的横断面研究,改善急腹症患者急性肠系膜缺血的临床怀疑：来自肠道卒中中心的横断面研究

Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls). We included 137 patients—52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55–74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7–60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2–16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77–0.91), depending on the number of factors. Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.,急性肠系膜缺血（AMI）的早期诊断对于获得良好的结果至关重要。选择需要专用多相计算机断层扫描 (CT) 扫描的患者仍然是一个临床挑战。在这项 2016 年至 2018 年进行的横断面诊断研究中，我们将入住肠道卒中中心的 AMI 患者的表现与入住急诊室的其他原因的急性腹痛患者（对照）进行了比较。我们纳入了 137 名患者，其中 52 名患有 AMI，85 名对照。AMI 患者[中位年龄：65 岁（四分位数范围 55-74）] 分别有 65% 和 35% 的病例患有动脉和静脉 AMI。与对照组相比，AMI 患者年龄明显更大，更有可能有危险因素或有心血管疾病史，更有可能出现突发性、需要吗啡的腹痛、便血、警戒、器官功能障碍、白细胞和中性粒细胞计数升高以及血浆 C 反应蛋白 (CRP) 和降钙素原浓度升高。多变量分析显示，两个独立因素与 AMI 的诊断相关：突然发作（OR = 20，95%CI 7-60，p < 0.001）和急性腹痛的吗啡需求性质（OR = 6） ，95%CI 2–16，p = 0.002）。88% 的 AMI 患者出现突然发作和/或需要吗啡的腹痛，而对照组为 28%（p < 0.001）。诊断 AMI 的受试者工作特征曲线下面积为 0.84 (95% CI 0.77–0.91)，具体取决于因素数量。,急性肠系膜缺血（AMI）的早期诊断对于获得良好的结果至关重要。选择需要专用多相计算机断层扫描 (CT) 扫描的患者仍然是一个临床挑战。在这项 2016 年至 2018 年进行的横断面诊断研究中，我们将入住肠道卒中中心的 AMI 患者的表现与入住急诊室的其他原因的急性腹痛患者（对照）进行了比较。我们纳入了 137 名患者，其中 52 名患有 AMI，85 名对照。AMI 患者[中位年龄：65 岁（四分位数范围 55-74）] 分别有 65% 和 35% 的病例患有动脉和静脉 AMI。与对照组相比，AMI 患者年龄明显更大，更有可能有危险因素或有心血管疾病史，更有可能出现突发性、需要吗啡的腹痛、便血、警戒、器官功能障碍、白细胞和中性粒细胞计数升高以及血浆 C 反应蛋白 (CRP) 和降钙素原浓度升高。多变量分析显示，两个独立因素与 AMI 的诊断相关：突然发作（OR = 20，95%CI 7-60，p < 0.001）和急性腹痛的吗啡需求性质（OR = 6） ，95%CI 2–16，p = 0.002）。88% 的 AMI 患者出现突然发作和/或需要吗啡的腹痛，而对照组为 28%（p < 0.001）。诊断 AMI 的受试者工作特征曲线下面积为 0.84 (95% CI 0.77–0.91)，具体取决于因素数量。