A Clinical Decision Rule to Establish the Diagnosis of Acute Diverticulitis at the Emergency Department
- 1 June 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 53 (6), 896-904
- https://doi.org/10.1007/dcr.0b013e3181d98d86
Abstract
The aim of this study was to identify patients in whom the clinical diagnosis of diverticulitis can be made with a high certainty, distinguishing them from patients requiring imaging. We prospectively recorded clinical features in patients with acute abdominal pain presenting at the emergency department, before they underwent imaging. We identified features significantly associated with a final diagnosis of acute diverticulitis using multivariate logistic regression analysis and developed a decision rule based on these features. We evaluated the performance of the rule in identifying patients with a high probability of having diverticulitis. In total, 112 of the 1021 patients (11%) had a final diagnosis of diverticulitis. Of the 126 patients with clinically suspected diverticulitis, 80 had a final diagnosis of diverticulitis. In 32 patients with diverticulitis as their final diagnosis, another clinical diagnosis was made. A decision rule was based on the 3 strongest clinical features: direct tenderness only in the left lower quadrant, the absence of vomiting, and a C-reactive protein >50 mg/L. Of the 126 clinically suspected patients, 30 patients had all 3 features (24%), of whom 29 had a final diagnosis of acute diverticulitis (97%; 95% CI: 83%-99%). Of the 96 patients without all 3 features, 45 (47%) did not have diverticulitis. In a quarter of patients with suspected diverticulitis, the diagnosis can be made clinically based on a combination of direct tenderness only in the left lower quadrant, the absence of vomiting, and an elevated C-reactive protein. In patients without these features, imaging is required to reach adequate diagnostic accuracy.Keywords
This publication has 19 references indexed in Scilit:
- Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy studyBMJ, 2009
- Comparison of Pediatric Emergency Physicians’ and Surgeons’ Evaluation and Diagnosis of AppendicitisAcademic Emergency Medicine, 2008
- DiverticulitisNew England Journal of Medicine, 2007
- Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationaleBMC Emergency Medicine, 2007
- Acute diverticulitis – clinical presentation and differential diagnosticsColorectal Disease, 2007
- Management of Acute Diverticulitis in the East Anglian Region: Results of a United Kingdom Regional SurveyDiseases of the Colon & Rectum, 2006
- Diverticular Disease of the ColonJournal of Clinical Gastroenterology, 1999
- Management of uncomplicated acute diverticulitisDiseases of the Colon & Rectum, 1999
- Generalized additive models for medical researchStatistical Methods in Medical Research, 1995
- Contributions of History-Taking, Physical Examination, and Computer Assistance to Diagnosis of Acute Small-Bowel Obstruction: A Prospective Study of 1333 Patients with Acute Abdominal PainScandinavian Journal of Gastroenterology, 1994