Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, 10 Vining St. Neville House, Boston, MA, 02115, USA.
Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, 02114, USA.
Sci Rep. 2024 Nov 2;14(1):26435. doi: 10.1038/s41598-024-78002-4.
The concern for diverticulitis often leads to the use of computed tomography (CT) scans for diagnosis. We aim to develop an ultrasound-based clinical decision rule (CDR) to confidently rule-out the disease without requiring a CT scan. We analyzed data from a prospective study of adult emergency department (ED) patients with suspected diverticulitis who underwent both bedside ultrasound (US) and CT. Patient history, physical examination, laboratory findings, and US results were used to create a CDR via a recursive partitioning model designed to prioritize sensitivity, with a loss matrix heavily penalizing false negatives. We calculated the test characteristics for this CDR (TICS-Rule) and assessed the potential reduction in CT scans and ED length of stay. Data from 149 patients (84 female; mean age 58 ± 16) were used to develop the TICS-Rule. The final model integrates US diagnosis of simple and complicated diverticulitis, along with variables of heart rate, age, history of diverticulosis, vomiting, and leukocytosis. Negative US results and a heart rate below 100 effectively excluded diverticulitis. The sensitivity increased from 54.5% (32.2-75.6) in the US alone to 100% (84.6-100%) for complicated diverticulitis in the model. The TICS-Rule missed no cases of complicated diverticulitis but one case of simple diverticulitis. The median time from ED greeting to US interpretation was 103 min (IQR 62-169), compared to 285 min (IQR 229-372) for CT. The TICS-Rule uses a combination of negative US and heart rate less thanQ1 100 to exclude diverticulitis without the need for a CT scan. Integration of the TICS-Rule offers a promising enhancement to clinical decision-making while reducing both CT use and ED length of stay.
人们通常会因为担心患有憩室炎而选择进行计算机断层扫描（CT）来进行诊断。本研究旨在开发一种基于超声的临床决策规则（CDR），以便在无需进行 CT 扫描的情况下，有信心地排除该疾病。我们分析了一项前瞻性研究的数据，该研究纳入了在急诊科就诊的疑似患有憩室炎的成年患者，这些患者均接受了床旁超声（US）和 CT 检查。患者的病史、体格检查、实验室检查和 US 结果用于通过递归分区模型创建 CDR，该模型旨在优先考虑敏感性，并通过损失矩阵对假阴性结果进行严格惩罚。我们计算了该 CDR（TICS-Rule）的测试特征，并评估了减少 CT 扫描和急诊科住院时间的潜力。数据来自 149 名患者（84 名女性；平均年龄 58±16 岁），用于开发 TICS-Rule。最终模型整合了简单和复杂憩室炎的 US 诊断，以及心率、年龄、憩室病史、呕吐和白细胞增多等变量。阴性 US 结果和心率低于 100 可有效排除憩室炎。模型中，复杂憩室炎的敏感性从单独使用 US 时的 54.5%（32.2-75.6）增加到 100%（84.6-100%）。TICS-Rule 没有漏掉任何复杂憩室炎的病例，但漏掉了 1 例简单憩室炎的病例。从急诊科接待到 US 解读的中位时间为 103 分钟（IQR 62-169），而 CT 则为 285 分钟（IQR 229-372）。TICS-Rule 使用阴性 US 和心率小于 Q1 100 的组合来排除憩室炎，无需进行 CT 扫描。该规则的整合为临床决策提供了有希望的改进，同时减少了 CT 检查的使用和急诊科住院时间。
