TY - JOUR
T1 - A Clinical Decision Rule to Establish the Diagnosis of Acute Diverticulitis at the Emergency Department
AU - Laméris, Wytze
AU - van Randen, Adrienne
AU - van Gulik, Thomas M.
AU - Busch, Olivier R. C.
AU - Winkelhagen, Jasper
AU - Bossuyt, Patrick M. M.
AU - Stoker, Jaap
AU - Boermeester, Marja A.
PY - 2010
Y1 - 2010
N2 - PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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
AB - PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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
U2 - https://doi.org/10.1007/DCR.0b013e3181d98d86
DO - https://doi.org/10.1007/DCR.0b013e3181d98d86
M3 - Article
C2 - 20485003
SN - 0012-3706
VL - 53
SP - 896
EP - 904
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 6
ER -