Outpatient Diverticulitis: Mild or Myth?
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Diverticulitis is considered common in the outpatient population, with mild variants of described diagnostic criteria: left lower quadrant pain, fever, and leukocytosis. Here, expected criteria utilization among outpatients with a possible diagnosis of diverticulitis is assessed.
Primary care acute clinic visits in 2008 for diverticulitis (ICD-9 562.11/562.13) or left lower quadrant pain (789.04) were identified among patients ≥40 years old. Encounters were reviewed through structured manual chart abstraction and evaluated for diagnostic accuracy compared to expected criteria. Analysis included inter-rater reliability (kappa tests) and descriptive frequencies by diagnosis code and diverticulitis rating (χ 2 tests).
A total of 376 acute visits were identified with codes for diverticulitis (n = 97) or left lower quadrant pain (n = 279). High inter-rater reliability was demonstrated for key clinical variables (kappa = 0.84–1.0). Left lower quadrant pain was reported in >75% of patients, while temperature and white blood cell count data were frequently unavailable. Lack of these expected criteria resulted in low diagnostic accuracy ratings (“No/unlikely”—53.6% diverticulitis, 88.2% left lower quadrant pain, p < 0.001).
This investigation raises concern for low accuracy in the outpatient diagnosis of diverticulitis due to inconsistent use of expected criteria, suggesting a smaller population with true diverticulitis than previously anticipated, or lack of criteria applicability in this setting.
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- Outpatient Diverticulitis: Mild or Myth?
Journal of Gastrointestinal Surgery
Volume 16, Issue 7 , pp 1389-1396
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- 1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, K4/734 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-3236, USA
- 2. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- 3. Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA