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J Gastrointest Surg. 2012 Jul;16(7):1389-96. doi: 10.1007/s11605-012-1861-2. Epub 2012 Mar 13.

Outpatient diverticulitis: mild or myth?

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  • 1Department of Surgery, University of Wisconsin School of Medicine and Public Health, K4/734 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3236, USA.

Abstract

BACKGROUND:

Diverticulitis is considered common in the outpatient population, with mild variants of described diagnostic criteria: left lower quadrant pain, fever, and leukocytosis. Here, expected criteria utilization among outpatients with a possible diagnosis of diverticulitis is assessed.

STUDY DESIGN:

Primary care acute clinic visits in 2008 for diverticulitis (ICD-9 562.11/562.13) or left lower quadrant pain (789.04) were identified among patients ≥ 40 years old. Encounters were reviewed through structured manual chart abstraction and evaluated for diagnostic accuracy compared to expected criteria. Analysis included inter-rater reliability (kappa tests) and descriptive frequencies by diagnosis code and diverticulitis rating (χ (2) tests).

RESULTS:

A total of 376 acute visits were identified with codes for diverticulitis (n=97) or left lower quadrant pain (n=279). High inter-rater reliability was demonstrated for key clinical variables (kappa=0.84-1.0). Left lower quadrant pain was reported in >75% of patients, while temperature and white blood cell count data were frequently unavailable. Lack of these expected criteria resulted in low diagnostic accuracy ratings ("No/unlikely"-53.6% diverticulitis, 88.2% left lower quadrant pain, p<0.001).

CONCLUSIONS:

This investigation raises concern for low accuracy in the outpatient diagnosis of diverticulitis due to inconsistent use of expected criteria, suggesting a smaller population with true diverticulitis than previously anticipated, or lack of criteria applicability in this setting.

PMID:
22411489
[PubMed - indexed for MEDLINE]
PMCID:
PMC3638980
Free PMC Article
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