Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.
BMC Emerg Med. 2024 Nov 9;24(1):210. doi: 10.1186/s12873-024-01127-2.
Acute diverticulitis is commonly misdiagnosed among patients with acute abdominal pain in the emergency department (ED). There are predictive scores that assist in the diagnosis of acute left-sided diverticulitis, but no scoring system is available for diagnosing acute diverticulitis without regard to the affected side. Therefore, developing a predictive score for diagnosing acute diverticulitis that is not limited to the left side will guide physicians in making a diagnosis and increase the appropriateness of computed tomography. This study aimed to establish a predictive score for diagnosing acute diverticulitis.
This single-centre retrospective study included adult patients (≥ 18 years) who presented to the ED with acute abdominal pain. Multivariate logistic regression analysis was used to identify essential factors for diagnosing acute diverticulitis, and the Akaike information criterion was calculated to identify significant predictive factors for diagnosing acute diverticulitis using a clinical scoring system.
Of 424 patients who fulfilled the inclusion criteria, 72 (17%) were diagnosed with acute diverticulitis. The significant factors associated with acute diverticulitis were age ≥ 60 years (adjusted odds ratio (adj.OR) 2.23, 95% confidence interval (CI): 1.20 - 4.14, p = 0.01), duration of abdominal pain ≥ 48 h (adj.OR 2.64, 95% CI: 1.28 - 5.45, p = 0.017), history of a diverticulum (adj.OR 7.77, 95% CI: 3.27 - 18.45, p < 0.001), absence of nausea and vomiting (adj.OR 3.42, 95% CI: 1.65 - 7.10, p < 0.001), absence of anorexia (adj.OR 3.33, 95% CI: 1.34 - 8.33, p = 0.026), absence of tachycardia (adj.OR 3.51, 95% CI: 1.39 - 8.87, p = 0.003), and abdominal guarding (adj.OR 2.99, 95% CI: 1.52 - 5.91, p = 0.002). These predictive factors were converted into predictive scores for diagnosing acute diverticulitis. For the score of ≥ 4, the sensitivity and specificity were 73.24% (95% CI: 0.61-0.83) and 80.40% (95% CI: 0.76-0.84), respectively, and the negative predictive value was 93.71% (95% CI: 0.90-0.96). No significant signs, symptoms, or laboratory findings were associated with complicated diverticulitis.
Predictive factors for diagnosing acute diverticulitis included age ≥ 60 years, duration of abdominal pain ≥ 48 h, history of a diverticulum, abdominal guarding, and absence of nausea and vomiting, anorexia, and tachycardia. A predictive score ≥ 4 suggested the presence of acute diverticulitis.
在急诊科（ED），急性憩室炎常被误诊为急性腹痛患者。有一些预测评分可以帮助诊断左侧急性憩室炎，但没有评分系统可用于诊断不考虑受累侧的急性憩室炎。因此，开发一种不限于左侧的用于诊断急性憩室炎的预测评分将有助于医生做出诊断，并提高计算机断层扫描的恰当性。本研究旨在建立一种用于诊断急性憩室炎的预测评分。
这是一项单中心回顾性研究，纳入了因急性腹痛到 ED 就诊的成年患者（≥18 岁）。使用多变量逻辑回归分析来确定诊断急性憩室炎的基本因素，并使用临床评分系统计算 Akaike 信息准则来确定诊断急性憩室炎的显著预测因素。
在符合纳入标准的 424 名患者中，72 名（17%）被诊断为急性憩室炎。与急性憩室炎相关的显著因素包括年龄≥60 岁（调整后的优势比（adj.OR）2.23，95%置信区间（CI）：1.20-4.14，p=0.01）、腹痛持续时间≥48 小时（adj.OR 2.64，95%CI：1.28-5.45，p=0.017）、憩室病史（adj.OR 7.77，95%CI：3.27-18.45，p<0.001）、无恶心和呕吐（adj.OR 3.42，95%CI：1.65-7.10，p<0.001）、无厌食（adj.OR 3.33，95%CI：1.34-8.33，p=0.026）、无心动过速（adj.OR 3.51，95%CI：1.39-8.87，p=0.003）和腹部紧张（adj.OR 2.99，95%CI：1.52-5.91，p=0.002）。这些预测因素被转化为用于诊断急性憩室炎的预测评分。评分≥4 分的灵敏度和特异性分别为 73.24%（95%CI：0.61-0.83）和 80.40%（95%CI：0.76-0.84），阴性预测值为 93.71%（95%CI：0.90-0.96）。没有显著的体征、症状或实验室发现与复杂的憩室炎有关。
诊断急性憩室炎的预测因素包括年龄≥60 岁、腹痛持续时间≥48 小时、憩室病史、腹部紧张以及无恶心、呕吐、厌食和心动过速。评分≥4 分提示存在急性憩室炎。
