Iyer Rajan, Longstreth George F, Chu Li-Hao, Chen Wansu, Yen Linnette, Hodgkins Paul, Kawatkar Aniket A
Department of Research and Evaluation Kaiser Permanente Southern California, Pasadena, CA, USA.
Global Health Economics and Outcomes Research Shire Development LLC, Wayne, PA, USA.
J Gastrointestin Liver Dis. 2014 Dec;23(4):379-86. doi: 10.15403/jgld.2014.1121.234.acdd.
Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features.
In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features.
Inpatients were older and more often underweight/normal weight and lacked a diverticulitis past history and had more comorbidities than other patients. Outpatients were most often Hispanic/Latino. The classical triad (abdominal pain, fever, leukocytosis) occurred in 78 (38.6%) inpatients, 29 (5.2%) outpatients and 34 (10.7%) emergency department cases. Computed tomography was performed on 196 (94.4%) inpatients, 110 (9.2%) outpatients and 296 (87.6%) emergency department cases and was diagnostic in 153 (78.6%) inpatients, 62 (56.4%) outpatients and 243 (82.1%) emergency department cases. Multiple variables affected presenting features. Notably, female sex had lower odds for the presence of the triad features (odds ratio [95% CI], 0.65 [0.45-0.94], P<0.05) and increased odds of vomiting (1.78 [1.26-2.53], P<0.01). Patients in age group 56 to 65 and 66 or older had decreased odds of fever (0.67 [0.46-0.98], P<0.05) and 0.46 [0.26-0.81], P<0.01), respectively, while > / =1 co-morbidity increased the odds of observing the triad (1.88 [1.26-2.81], P<0.01).
There was little objective evidence for physician-diagnosed diverticulitis in most outpatients. Demographic and clinical characteristics vary among settings and independently affect presenting features.
憩室炎常于门诊患者中诊断，但在不同医疗环境下，关于诊断依据及人口统计学/临床特征的证据较少。我们评估了住院患者、门诊患者及急诊科病例的临床特征和诊断依据的差异，以及人口统计学和临床变量对临床表现特征的影响。
在一项针对综合医疗系统中1749例患者的回顾性队列研究中，我们比较了不同医疗环境下的临床表现和计算机断层扫描结果，并评估了人口统计学和临床因素对临床表现的独立影响。
住院患者年龄较大，体重过轻/正常体重的比例更高，且缺乏憩室炎病史，合并症比其他患者更多。门诊患者大多为西班牙裔/拉丁裔。典型三联征（腹痛、发热、白细胞增多）在78例（38.6%）住院患者、29例（5.2%）门诊患者和34例（10.7%）急诊科病例中出现。196例（94.4%）住院患者、110例（9.2%）门诊患者和296例（87.6%）急诊科病例进行了计算机断层扫描，其中153例（78.6%）住院患者、62例（56.4%）门诊患者和243例（82.1%）急诊科病例的扫描结果具有诊断意义。多个变量影响临床表现。值得注意的是，女性出现三联征特征的几率较低（优势比[95%置信区间]，0.65[0.45 - 0.94]，P<0.05），呕吐几率增加（1.78[1.26 - 2.53]，P<0.01）。56至65岁和66岁及以上年龄组的患者发热几率分别降低（0.67[0.46 - 0.98]，P<0.05）和0.46[0.26 - 0.81]，P<0.01），而≥1种合并症会增加出现三联征的几率（1.88[1.26 - 2.81]，P<0.01）。
在大多数门诊患者中，医生诊断憩室炎的客观证据较少。不同医疗环境下的人口统计学和临床特征存在差异，并独立影响临床表现。
