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Updated: Oct 25, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Multi-center validation of the Bowel Injury Predictive Score (BIPS) for the early identification of need to operate
Michael Wandling1, Joseph Cuschieri2, Rosemary Kozar3
1McGovern Medical School at UT Health, 6410 Fannin St, Houston, TX 77030, USA.
Insights
The Bowel Injury Prediction Score (BIPS) accurately predicts the need for surgery in blunt bowel and mesenteric injury (BBMI) patients. A BIPS score of 2 or higher indicates a higher likelihood of operative intervention.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Diagnostic Accuracy
Background:
- Blunt bowel and mesenteric injury (BBMI) poses a significant challenge in trauma care.
- The Bowel Injury Prediction Score (BIPS) was developed to identify patients requiring surgical intervention for BBMI.
- BIPS considers WBC count, abdominal tenderness, and CT scan injury grade.
Purpose of the Study:
- To prospectively validate the Bowel Injury Prediction Score (BIPS) in a multi-center setting.
- To assess BIPS's effectiveness in predicting operative intervention for BBMI.
- To evaluate BIPS performance in trauma patients, including those with altered mental status.
Main Methods:
- Prospective enrollment of 313 patients with suspected BBMI across 15 U.S. trauma centers.
- Calculation of BIPS for each patient based on predefined criteria (WBC, tenderness, CT grade).
- Comparison of BIPS scores with surgical outcomes to determine predictive value.
Main Results:
- A BIPS score ≥ 2 was associated with a >10-fold increased likelihood of laparotomy (OR 10.1).
- The BIPS demonstrated a sensitivity of 72% and specificity of 78% for predicting BBMI requiring surgery.
- In patients with severe altered mental status, BIPS showed high specificity (92%) and PPV (82%).
Conclusions:
- The multi-center trial validates BIPS as a reliable predictor of BBMI requiring surgery.
- BIPS serves as a valuable tool for surgeons in managing blunt bowel and mesenteric injuries.
- The score aids in operative versus non-operative decision-making, even in complex trauma cases.
Introduction:
The Bowel Injury Prediction Score (BIPS) is a tool for identifying patients at risk for blunt bowel and mesenteric injury (BBMI) requiring surgery. BIPS is calculated by assigning one point for each of the following: (1) WBC ≥ 17,000, (2) abdominal tenderness, and (3) injury grade ≥ 4 (mesenteric contusion or hematoma with bowel wall thickening or adjacent interloop fluid collection) on CT scan. A total score ≥ 2 is associated with BBMI requiring surgery. We aimed to validate the BIPS as a predictor for patients with BBMIs requiring operative intervention in a multi-center prospective study.
Materials And Methods:
Patients were prospectively enrolled at 15 U.S. trauma centers following blunt trauma with suspicion of BBMI on CT scan between July 1, 2018 and July 31, 2019. The BIPS was calculated for each patient enrolled in the study.
Results:
Of 313 patients, 38% had BBMI requiring operative intervention. Patients were significantly more likely to require surgery in the presence of abdominal tenderness (OR, 3.6; 95% CI, 1.6-8.0) and CT grade ≥ 4 (OR, 11.7; 95% CI, 5.7-23.7). Patients with a BIPS ≥ 2 were more than ten times more likely to require laparotomy than those with a BIPS < 2 (OR, 10.1; 95% CI, 5.0-20.4). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a BIPS ≥ 2 for BBMI requiring surgery was 72% (CI 0.6-0.8), 78% (CI 0.7-0.8), 67% (CI 0.6-0.8), and 82% (CI 0.8-0.9), respectively. The AUROC curve for BIPS ≥ 2 was 0.75. The sensitivity, specificity, PPV, and NPV of a BIPS ≥ 2 for BBMI requiring surgery in patients with severe alteration in mental status (GCS 3-8) was 70% (CI 0.5-0.9), 92% (CI 0.8-1.0), 82% (CI 0.6-1.0), and 86% (CI 0.7-1.0), respectively.
Conclusion:
This prospective multi-center trial validates BIPS as a predictor of BBMI requiring surgery. Calculation of BIPS during the initial evaluation of trauma patients is a useful adjunct to help general surgeons taking trauma call determine operative versus non-operative management of patients with BBMI including those with severe alteration in mental status.
