STUDY QUESTIONS. STUDY PATIENTS

STUDY QUESTIONS

1. What is the incidence of AMI (= percentage ofadult admissions) in acute care hospitals?

2. What are the proportions of the different forms of mesenteric ischaemia?

3. What are the common baselinecharacteristics in patients with AMI and in its different forms?

4. What is the proportion of patients with confirmed AMI from all patients with suspected AMI?

5. Which are the differences in patient characteristics at baseline betweenpatients with confirmed and those with suspected but not confirmed AMI?

6. Which factors appear to cause delay in diagnosis and management of AMI?

7. Which methods are used to diagnose AMI (including chronological order)?

8. Which methods are used to manage the different forms of AMI (including the chronological order of interventions)?

9. What is the outcome of mesenteric ischaemia?

STUDY PATIENTS

The study flow is illustrated in Figure 1.

All adult patients acutely hospitalized at the study site during a 6 month period will be screened for suspected or confirmed mesenteric ischaemia. Chronic care, paediatric and psychiatry wards will not be screened for inclusion of patients.

Screening and data collection will be organized by the local primary investigator at each site. We suggest that the primary investigator at each site informs all the units in the hospital, whoneed to agree and undertake to inform the primary investigator immediately whenever a suspicion of AMI arises. Respective information chart templates will be provided to each site.

All patients with suspicion of or confirmed AMI are to be included in the study in accordance with local ethics requirements:

· If suspicion of AMI is NOT confirmed, only baseline data and hospital mortality outcome is collected

· ifthe diagnosis of AMI is confirmed, then full data collection is required

Two different groups of patients are specifically screened:

1) Suspected or confirmed occlusive mesenteric ischaemia or infarction. These patients (in the emergency room or hospital ward) commonly present with severe abdominal pain of acute onset, diarrhoea and/or vomiting. Mesenteric ischaemia or infarction in these patients could be diagnosed by: abdominal CT with intravenous contrast enhancement, preferably with imaging in the arterial and venous phases, angiography, endoscopy, or laparotomy/laparoscopy.

2) Suspected or confirmed non-occlusive mesenteric ischaemia (patients with primarily non-occlusive ischaemia may or may not develop intestinal infarction). These patients are commonly in intensive care / high dependency units (usually receiving vasopressor/inotropic support) and present with (often non-specific) abdominal symptoms with or without elevated blood lactate values. Abdominal CT with intravenous contrast enhancement, and preferably imaging in the arterial phase toexclude occlusive mesenteric thromboembolism and the venous phase to evaluate intestinal injury, is usually needed. Diagnosis of transmural ischaemia may be confirmed during laparotomy or laparoscopy, and non-transmural mucosal ischaemia during endoscopy.

Readmission: if included patient in whom AMI was suspected but not confirmed is readmitted with suspicion of or confirmed AMI during the study period, inclusion of this case should be discussed with PI.

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