Evaluation of Clinical Assessment in Predicting Complicated Acute Diverticulitis.

ABSTRACT

Background Acute diverticulitis is a common surgical condition and one of the leading gastrointestinal conditions that require hospital admission. The presence of complications increases the hospital stay and risk of requiring surgical intervention. This study aimed to investigate the clinical features that can be identified during clinical assessment and evaluate their predictive value and sensitivity in differentiating between complicated and uncomplicated diverticulitis. Methodology This retrospective case-control study was performed on patients with acute diverticulitis at Lyell McEwin Hospital, Adelaide, South Australia. Data were collected for patients presenting from January 2015 to December 2017. Patients with acute diverticulitis confirmed by computed tomography (CT) were included in the study. Multiple clinical assessment aspects were reported and compared between complicated diverticulitis and uncomplicated diverticulitis groups. Results Data from a total of 116 cases were collected, 10 of which were excluded due to lack of CT diagnosis. Forty-four cases had complicated diverticulitis (case group), and 62 cases had uncomplicated diverticulitis (control group). Twenty-three cases (52.2%) had the first episode of diverticulitis in the complicated group compared to 24 cases (38.7%) in the uncomplicated group, with an odds ratio of 1.73 (0.79-3.789). Eight cases (18.2%) had previously complicated diverticulitis in the complicated group compared to 11 cases (17.7%) in the uncomplicated group, with an odds ratio of 1.03 (0.37-2.82). Six cases (13.6%) had a fever (T > 38) in the complicated group compared to two cases (3.2%) in the uncomplicated group, with an odds ratio of 4.74 (0.9-24.7), a sensitivity of only 13.64%, and a specificity of 96.77%. Twelve cases (27.3%) had tachycardia, two cases (4.5%) had hypotension, and five cases (11.4%) had peritonism in the complicated group compared to two cases (3.2%), one case (1.6%), and one case (1.6%) in the uncomplicated group, with odds ratios of 11.25 (2.37-53.4), 2.9 (0.255-33), and 7.82 (0.88-69.5), respectively; sensitivity was 27.27%, 4.55%, and 11.36% for tachycardia, hypotension, and peritonism, whereas specificity was 96.77%, 98.39%, and 98.39%, respectively. Conclusions The study found no significant correlation between having complicated diverticulitis and previous episodes of complicated diverticulitis, immunosuppression, pain severity, or change in bowel habits. Perrectal bleeding was found to reduce the risk of having complicated diverticulitis. Our results did not demonstrate a statistically significant relationship between the first episode of diverticulitis and having complicated diverticulitis. Physical signs, when abnormal, are highly specific in predicting complicated diverticulitis. Tachycardia was found to have the highest positive predictive value and odds ratio compared to the other observed physical signs.