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The high rates of potential complications that are associated with an SBO<\/jats:styled-content> make it essential for the emergency physician (EP<\/jats:styled-content>) to make a timely and accurate diagnosis.<\/jats:p><\/jats:sec>Objectives<\/jats:title>The primary objective was to perform a systematic review and meta\u2010analysis of the history, physical examination, and imaging modalities associated with the diagnosis of SBO<\/jats:styled-content>. The secondary objectives were to identify the prevalence of SBO<\/jats:styled-content> in prospective ED<\/jats:styled-content>\u2010based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision\u2010making to the diagnosis and management of SBO<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>MEDLINE<\/jats:styled-content>, EMBASE<\/jats:styled-content>, major emergency medicine (EM<\/jats:styled-content>) textbooks, and the bibliographies of selected articles were scanned for studies that assessed one or more components of the history, physical examination, or diagnostic imaging modalities used for the diagnosis of SBO<\/jats:styled-content>. The selected articles underwent a quality assessment by two of the authors using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS<\/jats:styled-content>\u20102) tool. Data used to compile sensitivities and specificities were obtained from these studies and a meta\u2010analysis was performed on those that examined the same historical component, physical examination technique, or diagnostic test. Separate information on the prevalence and management of SBO<\/jats:styled-content> was used in conjunction with the meta\u2010analysis findings of computed tomography (CT<\/jats:styled-content>) to determine the test and treatment threshold.<\/jats:p><\/jats:sec>Results<\/jats:title>The prevalence of SBO<\/jats:styled-content> in the ED<\/jats:styled-content> was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and\/or abdominal distention on examination were the best history and physical examination predictors of SBO<\/jats:styled-content>. X\u2010ray was determined to be the least useful imaging modality for the diagnosis of SBO<\/jats:styled-content>, with a pooled positive likelihood ratio (+LR<\/jats:styled-content>) of 1.64 (95% confidence interval [CI<\/jats:styled-content>]\u00a0=\u00a01.07 to 2.52). On the other hand, CT<\/jats:styled-content> and magnetic resonance imaging (MRI<\/jats:styled-content>) were both quite accurate in diagnosing SBO<\/jats:styled-content> with +LR<\/jats:styled-content>s of 3.6 (5\u2010 to 10\u2010mm slices, 95% CI<\/jats:styled-content>\u00a0=\u00a02.3 to 5.4) and 6.77 (95% CI<\/jats:styled-content>\u00a0=\u00a02.13 to 21.55), respectively. Although limited to only a select number of studies, the use of ultrasound (US<\/jats:styled-content>) was determined to be superior to all other imaging modalities, with a +LR<\/jats:styled-content> of 14.1 (95% CI<\/jats:styled-content>\u00a0=\u00a03.57 to 55.66) and a negative likelihood ratio (\u2013LR<\/jats:styled-content>) of 0.13 (95% CI<\/jats:styled-content>\u00a0=\u00a00.08 to 0.20) for formal scans and a +LR<\/jats:styled-content> of 9.55 (95% CI<\/jats:styled-content>\u00a0=\u00a02.16 to 42.21) and a \u2013LR<\/jats:styled-content> of 0.04 (95% CI<\/jats:styled-content>\u00a0=\u00a00.01 to 0.13) for beside scans. Using the CT<\/jats:styled-content> results of the meta\u2010analysis for the 5\u2010 to 10\u2010mm slice subgroup as well as information on intravenous (IV<\/jats:styled-content>) contrast reactions and nasogastric (NG<\/jats:styled-content>) intubation management, the pretest probability threshold for further testing was determined to be 1.5%, and the pretest probability threshold for beginning treatment was determined to be 20.7%.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The potentially useful aspects of the history and physical examination were limited to a history of abdominal surgery, constipation, and the clinical examination findings of abnormal bowel sounds and abdominal distention. CT<\/jats:styled-content>, MRI<\/jats:styled-content>, and US<\/jats:styled-content> are all adequate imaging modalities to make the diagnosis of SBO<\/jats:styled-content>. Bedside US<\/jats:styled-content>, which can be performed by EP<\/jats:styled-content>s, had very good diagnostic accuracy and has the potential to play a larger role in the ED<\/jats:styled-content> diagnosis of SBO<\/jats:styled-content>. More ED<\/jats:styled-content>\u2010focused research into this area will be necessary to bring about this change.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12150","type":"journal-article","created":{"date-parts":[[2013,6,12]],"date-time":"2013-06-12T16:20:45Z","timestamp":1371054045000},"page":"527-544","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":136,"title":["Adult Small Bowel Obstruction"],"prefix":"10.1111","volume":"20","author":[{"given":"Mark R.","family":"Taylor","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Saskatchewan Saskatoon SK Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadim","family":"Lalani","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Saskatchewan Saskatoon SK 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