Department of Surgery, Kaiser Permanente, Los Angeles, CA, USA.
Colorectal Dis. 2013 Apr;15(4):451-7. doi: 10.1111/codi.12057.
Current recommendations regarding the triage of patients with acute diverticulitis for inpatient or outpatient treatment are vague. We hypothesized that a significant number of patients treated as an inpatient could be managed as an outpatient.
A retrospective cohort study was carried out of 639 patients admitted for a first episode of diverticulitis. The diagnosis of acute diverticulitis was confirmed by computed tomography (CT). The endpoints included length of stay, need for surgery, percutaneous drainage and mortality. Patients were considered to have had a minimal hospitalization, defined as survival to discharge without needing a procedure, hospitalization of ≤ 3 days and no readmission for diverticulitis within 30 days after discharge.
Of 639 patients, 368 (57.6%) had a minimal hospitalization. Female gender and CT scan findings of free air/fluid were negatively associated with the likelihood of minimal hospitalization. The presence of an abscess < 3 cm and stranding on CT did not predict the need for a higher level of care. Despite the statistical significance of several patient-level predictors, the model did not identify patients likely to need only minimal hospitalization.
Most patients admitted with acute diverticulitis are discharged after minimal hospitalization. Free air/liquid in a patient admitted for acute diverticulitis indicates a more severe clinical course.
目前对于急性憩室炎患者分诊为住院或门诊治疗的建议较为模糊。我们假设，相当数量的住院治疗患者可以作为门诊患者进行管理。
对 639 例因首次发作憩室炎入院的患者进行了回顾性队列研究。通过计算机断层扫描（CT）确诊急性憩室炎。终点包括住院时间、手术需要、经皮引流和死亡率。患者被认为有轻微住院，定义为无需手术即可存活出院、住院≤3 天且出院后 30 天内无憩室炎再入院。
在 639 例患者中，368 例（57.6%）有轻微住院。女性和 CT 扫描发现自由气/液与轻微住院的可能性呈负相关。脓肿<3cm 和 CT 上的条索状影并不预测需要更高水平的治疗。尽管有几个患者水平预测因素具有统计学意义，但该模型并未确定哪些患者可能只需要轻微住院。
大多数因急性憩室炎入院的患者经轻微住院后出院。在因急性憩室炎入院的患者中存在自由气/液表明更严重的临床病程。
