*Departments of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands.
Ann Surg. 2011 May;253(5):940-6. doi: 10.1097/SLA.0b013e3182113614.
The aim of this study was to assess and compare the diagnostic value of elements of the disease history, physical examination, and routine laboratory tests in patients with suspected acute left-sided colonic diverticulitis (ALCD).
Misdiagnosis rates for diverticulitis vary in literature between 34% and 68% which needs improvement. Because of the frequent misdiagnosis, liberal use of imaging has been recommended. Before making a plea for routine imaging, the diagnostic accuracy of different variables of disease history, physical examination, and routine laboratory tests needs to be specified.
All patients seen on the emergency department because of acute abdominal pain suspected of ALCD in whom an abdominal computed tomography was performed, between January 2002 and March 2006, were studied. Univariate logistic regression was used to study differences in patients' characteristics and symptoms, findings at physical examination and routine laboratory tests between patients with and without ALCD. Independent predictors to the risk of ALCD were identified using multivariate logistic regression and used to create a clinical scoring system.
Of 1290 patients with acute abdominal pain, 287 patients were eligible for analysis. Acute left-sided colonic diverticulitis was the final diagnosis in 124 patients (43%). Age, 1 or more previous episodes, localization of symptoms in the lower left abdomen, aggravation of pain on movement, the absence of vomiting, localization of abdominal tenderness in the lower left abdomen, and C-reactive protein 50 or more were found to be independent predictors of ALCD. A nomogram was constructed based on these independent predictors with a diagnostic accuracy of 86%.
This study showed that the clinical diagnosis of diverticulitis is difficult to make but can be improved using a clinical scoring system. In case of a high chance of ALCD based on the nomogram, additional imaging may not be needed.
本研究旨在评估和比较疑似急性左侧结肠憩室炎（ALCD）患者的病史、体格检查和常规实验室检查各项要素的诊断价值。
文献中憩室炎的误诊率在 34%至 68%之间，需要加以改进。由于经常误诊，因此建议广泛使用影像学检查。在倡导常规影像学检查之前，需要明确病史、体格检查和常规实验室检查各项变量的诊断准确性。
对 2002 年 1 月至 2006 年 3 月期间因疑似 ALCD 而在急诊就诊并接受腹部计算机断层扫描的所有急性腹痛患者进行研究。使用单变量逻辑回归分析患者特征和症状、体格检查和常规实验室检查结果在 ALCD 患者和非 ALCD 患者之间的差异。使用多变量逻辑回归确定 ALCD 的独立预测因子，并用于创建临床评分系统。
在 1290 例急性腹痛患者中，有 287 例符合分析条件。最终诊断为急性左侧结肠憩室炎的患者有 124 例（43%）。年龄、1 次或多次既往发作、症状位于左下腹部、运动时疼痛加剧、无呕吐、腹部压痛位于左下腹部、C 反应蛋白 50mg/L 或更高，这些是 ALCD 的独立预测因子。基于这些独立预测因子构建了一个列线图，其诊断准确性为 86%。
本研究表明，憩室炎的临床诊断较为困难，但可以使用临床评分系统加以改善。如果根据列线图预测 ALCD 的可能性较高，则可能不需要额外的影像学检查。
