Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
J Gastrointest Surg. 2010 Feb;14(2):303-8. doi: 10.1007/s11605-009-1098-x.
Diverticular disease is common in the outpatient setting; yet, rigorous study of diagnosis and management strategies is currently limited to hospitalized patients. Here, we characterize the clinical assessment generating the diagnostic label of diverticulitis in outpatients.
Encounters for diverticulitis were identified using ICD-9 diagnosis codes (562.11/562.13) from the electronic medical record system of a tertiary referral hospital and its regional clinics. The frequencies of various demographic and clinical variables were compared between patients presenting in the emergency room (ER) or outpatient Clinic.
Between 2003 and 2008, 820 inpatients and 2,576 outpatients met inclusion criteria (328 [13%] ER, 2,248 [87%] Clinic). Compared to ER patients, Clinic patients were less likely to undergo urgent abdominal/pelvic computed tomography (CT) scan (14% vs. 85%, p<.0001) or have an abnormal WBC count (35% vs. 69%, p<.0001). Twenty-four hour , including inpatient admission (30% ER vs. 3.5% Clinic, p<.0001) and colectomy (1.2% ER vs. 0.4% Clinic, p=0.08) were rare in both groups.
Diverticulitis in the outpatient setting is often characterized by infrequent use of CT scans, lack of leukocytosis, and rare need for urgent surgery or early admission. As this diagnostic label appears to be commonly applied without objective evidence, further study is needed to evaluate its validity.
憩室疾病在门诊中很常见；然而，目前对其诊断和治疗策略的严格研究仅限于住院患者。在这里，我们描述了在门诊患者中生成憩室炎诊断标签的临床评估。
使用三级转诊医院及其地区诊所的电子病历系统中的 ICD-9 诊断代码（562.11/562.13）识别憩室炎的就诊记录。比较急诊科（ER）和门诊患者的各种人口统计学和临床变量的频率。
2003 年至 2008 年，820 名住院患者和 2576 名门诊患者符合纳入标准（328 名 ER，2248 名 Clinic）。与 ER 患者相比，Clinic 患者更不可能进行紧急腹部/盆腔 CT 扫描（14%比 85%，p<.0001）或出现异常白细胞计数（35%比 69%，p<.0001）。24 小时内（包括住院治疗（30%ER 比 3.5%Clinic，p<.0001）和结肠切除术（1.2%ER 比 0.4%Clinic，p=0.08）在两组中都很少见。
门诊憩室炎的特点通常是 CT 扫描不频繁、白细胞计数不高、紧急手术或早期入院的需求罕见。由于这个诊断标签似乎是在没有客观证据的情况下经常应用的，因此需要进一步研究来评估其有效性。
