Predictive Score in Diagnosing Acute Colonic Diverticulitis at the Emergency Department: A retrospective study

Abstract

Abstract Background: Acute diverticulitis was one of the common misdiagnoses among patients with acute abdominal pain in the emergency department (ED). The gold standard for diagnosing acute diverticulitis is a computerized tomography (CT) scan. Currently, no standard criteria have been established for diagnosing acute diverticulitis clinically. Therefore, the development of the predictive score for the diagnosis of acute diverticulitis will guide the physician in making a diagnosis and increase the appropriateness of the CT scan. Method: A single-center retrospective study, conducted in adult patients aged more than 18 years who presented with acute abdominal pain at the ED, aimed to establish a predictive score for diagnosing acute diverticulitis. A multivariate logistic regression analysis was used to identify essential factors for the diagnosis of acute diverticulitis. The Akaike information criterion (AIC) was calculated to identify significant predictive factors for the probability of diagnosing acute diverticulitis and presented in a nomogram. Results: There were 424 patients that fulfilled the inclusion criteria and 72 patients (17%) were diagnosed with acute diverticulitis. The significant predictive factors for the diagnosis of acute diverticulitis were age (adjust odd ratio (adj.OR) 1.03, 95% Confidence IntervaI (CI): 1.02-1.05), duration 24-72 hr (adj.OR 1.96, 95% CI: 0.97-3.95), duration >72 hr (adj.OR 3.22, 95% CI: 1.24-8.33), watery diarrhea (adj.OR 2, 95% CI: 0.97-4.15), nausea (adj.OR 0.43, 95%CI: 0.17-1.09), vomit (adj.OR 0.4, 95% CI: 0.11-1.38), right lower quadrant (RLQ) or left lower quadrant (LLQ) pain (adj.OR 3.48, 95% CI: 1.79-6.79), history of diverticulum (adj.OR 8.42, 95% CI: 3.61-19.63), LLQ tenderness (adj.OR 0.78, 95% CI: 0.36-1.7) and anorexia (adj.OR 0.23, 95% CI: 0.09-0.56). The seven clinical predictive variables for diagnosis acute diverticulitis of the nomogram consisted of 1) age, 2) nausea, 3) vomiting, 4) RLQ or LLQ pain, 5) duration of abdominal pain, 6) watery diarrhea, and 7) history of diverticulum. The total score of 135 was likely to diagnose acute diverticulitis with a sensitivity of 81.69% and a specificity of 70.94 %. The Area under the curve was 0.84. The secondary outcome, there were no signs, symptoms, or laboratory findings associated with complicated diverticulitis. Conclusion: Significant predictive factors for diagnosis of acute diverticulitis were age, absence of nausea, absence of vomiting, RLQ or LLQ pain, duration of abdominal pain, watery diarrhea and history of diverticulum.