Continuation Development Santichatngam’s Colonic Injury Prediction Score (SCOPES) for Decision Making in Colonic Injuries due to Trauma
DOI:
https://doi.org/10.64387/tjs.2025.275562Keywords:
Clinical prediction score, Colonic injuryAbstract
Background: Primary repair, a method involving direct repair of colonic injuries, has emerged as a preferred treatment option. The development of the SCOPES scoring system has significantly enhanced decision-making regarding primary repair versus diversion procedures. SCOPES version I effectively predicts optimal patients for primary repair, while version II accurately identifies those requiring diversion. By providing a more systematic approach, SCOPES has reduced variability in clinical decision-making. Given the lack of a gold standard for managing colonic injuries, this study seeks to assess the clinical utility of SCOPES versions I, II, and III in patients with colonic injuries.
Patients and Methods: A four-year retrospective study was conducted involving 34 patients with colonic injuries from Pranangklao Hospital and Maharat Nakhon Ratchasima Hospital. Medical records were reviewed from October 2020 to September 2024.
Results: The majority of patients were working-age males with an average age of 38 years. Motor vehicle accidents were the primary cause of injuries, resulting in blunt trauma more frequently than penetrating trauma. The right colon was the most common site of injury. A comparison of primary repair and diversion procedures revealed that primary repair was associated with better outcomes and fewer complications. The study found that SCOPES version I was effective in predicting patients suitable for primary repair, although it had certain limitations. SCOPES versions II and III were more effective in predicting patients who required diversion compared to SCOPES version I. These versions demonstrated 100% sensitivity, specificity, accuracy, positive and negative predictive values, and had a significant impact on positive and negative likelihood ratios, diagnostic odds ratios, and posttest odds.
Conclusion: SCOPES versions II and III, designed for diversion procedures, outperformed SCOPES version I, which was developed for primary repair. These versions exhibited significantly better predictive accuracy compared to relying solely on clinical judgment or surgical judgment.
References
Cho SD, Kiraly LN, Flaherty SF, et al. Management of colonic injuries in the combat theater. Dis Colon Rectum. 2010;53(5):728-34. doi: 10.1007/DCR.0b013e3181d326fd.
Maxwell RA, Fabian TC. Current management of colon trauma. World J Surg. 2003;27(6):632-9. doi: 10.1007/s00268-003-6762-9.
Demetriades D, Murray JA, Chan L, et al. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma. 2001;50(5):765-75. doi: 10.1097/00005373-200105000-00001.
Gonzalez RP, Falimirski ME, Holevar MR. Further evaluation of colostomy in penetrating colon injury. Am Surg. 2000;66(4):342-6.
Murray JA, Demetriades D, Colson M, et al. Colonic resection in trauma: colostomy versus anastomosis. J Trauma. 1999;46(2):250-4. doi: 10.1097/00005373-199902000-00009.
Eshraghi N, Mullins RJ, Mayberry JC, et al. Surveyed opinion of American trauma surgeons in management of colon injuries. J Trauma. 1998;44(1):93-7. doi: 10.1097/00005373-199801000-00009.
Pezim ME, Vestrup JA. Canadian attitudes toward use of primary repair in management of colon trauma. A survey of 317 members of the Canadian Association of General Surgeons. Dis Colon Rectum. 1996;39(1):40-4. doi: 10.1007/BF02048267.
Ivatury RR, Gaudino J, Nallathambi MN, et al. Definitive treatment of colon injuries: a prospective study. Am Surg. 1993;59(1):43-9.
Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30(11):1427-9.
George SM Jr, Fabian TC, Voeller GR, et al. Primary repair of colon wounds. A prospective trial in nonselected patients. Ann Surg. 1989;209(6):728-33. doi: 10.1097/00000658-198906000-00010.
Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg. 1979;190(4):430-6. doi: 10.1097/00000658-197910000-00002.
Santichatngam P. Santichatngam’s Colonic Injury Prediction Score (SCOPES). Thai J Surg. 2017;38(2):53-8.
Wattakawanick B, Santichatngam P. Reliability of Santichatn¬gam’s colonic Injury prediction score (SCOPES) at Maharat Nakhon Ratchasima Hospital (MNRH). Paper presented at the 34th regional meeting of The Royal College of Surgeons of Thailand, Shangri-la Hotel, Chiang Mai, Thailand. [unpublished]
Santichatngam P. Santichatngam’s Colonic Injury Prediction Score (SCOPES) for Decision Making in Colonic Injury Due to Trauma. Thai J Surg. 2022;43(1):12-7.
Cullinane DC, Jawa RS, Como JJ, et al. Management of penetrating intraperitoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2019;86(3):505-15. doi: 10.1097/TA.0000000000002146.
Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling. III: Chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma. 1992;33(3):337-9.
Brady RR, O'Neill S, Berry O, et al. Traumatic injury to the colon and rectum in Scotland: demographics and outcome. Colorectal Dis. 2012;14(1):e16-22. doi: 10.1111/j.1463-1318.2011.02753.x.
Oosthuizen GV, Kong VY, Estherhuizen T, et al. The impact of mechanism on the management and outcome of penetrating colonic trauma. Ann R Coll Surg Engl. 2018;100(2):152-6. doi: 10.1308/rcsann.2017.0147.
Chamieh J, Prakash P, Symons WJ. Management of Destructive Colon Injuries after Damage Control Surgery. Clin Colon Rectal Surg. 2018;31(1):36-40. doi: 10.1055/s-0037-1602178.
Sağıroğlu T, Tunca F, Eren E, et al. Retrospective evaluation of colon injury cases. Eurasian J Med. 2008;40(1):29-32.
Falcone RE, Carey LC. Colorectal trauma. Surg Clin North Am. 1988;68(6):1307-18. doi: 10.1016/s0039-6109(16)44688-8.
Okies JE, Bricker DL, Jordan GL, et al. Exteriorized primary repair of colon injuries. Am J Surg. 1972 Dec;124(6):807-10. doi: 10.1016/0002-9610(72)90145-6.
Woodhall JP, Ochsner A. The management of perforating injuries of the colon and rectum in civilian practice. Surgery. 1951;29(2):305-20.
Burch JM, Brock JC, Gevirtzman L, et al. The injured colon. Ann Surg. 1986;203(6):701-11. doi: 10.1097/00000658-198606000-00016.
Durham RM, Pruitt C, Moran J, et al. Civilian colon trauma: factors that predict success by primary repair. Dis Colon Rectum. 1997;40(6):685-92. doi: 10.1007/BF02140898.
Jinescu G, Lica I, Beuran M. Traumatic colon injuries -- factors that influence surgical management. Chirurgia (Bucur). 2013;108(5):652-8.
Zeineddin A, Tominaga GT, Crandall M, et al. Contemporary management and outcomes of penetrating colon injuries: Validation of the 2020 AAST Colon Organ Injury Scale. J Trauma Acute Care Surg. 2023;95(2):213-9. doi: 10.1097/TA.0000000000003969.
Altiok M, Tümer H, Sarıtaş AG. Evaluation of the predictive effects of trauma scoring systems in colorectal injuries. Eur J Trauma Emerg Surg. 2024;50(1):269-74. doi: 10.1007/s00068-023-02328-3.
![[TJS 46-4 01] Table 4](https://he02.tci-thaijo.org/public/journals/683/submission_275562_59861_coverImage_en_US.png)
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Royal College of Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
