Outpatient Diverticulitis: Mild or Myth?

• Published in: Journal of gastrointestinal surgery 2012-07, Vol.16 (7), p.1389-1396
• Main Authors: O’Connor, Erin S., Smith, Maureen A., Heise, Charles P.
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Pain - etiology; Accuracy; Adult; Aged; Aged, 80 and over; Ambulatory Care - standards; Ambulatory Care - statistics & numerical data; Clinics; Disease; Diverticulitis; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - diagnosis; Female; Fever; Fever - etiology; Gastroenterology; Guideline Adherence - statistics & numerical data; Humans; Leukocytes; Leukocytosis - etiology; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Observer Variation; Original Article; Pain; Patients; Population; Practice Guidelines as Topic; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Primary care; Public health; Surgery; Wisconsin
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-012-1861-2

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