Journal of Gastrointestinal Surgery

, Volume 16, Issue 7, pp 1389–1396

Outpatient Diverticulitis: Mild or Myth?

  • Erin S. O’Connor
  • Maureen A. Smith
  • Charles P. Heise
Original Article

DOI: 10.1007/s11605-012-1861-2

Cite this article as:
O’Connor, E.S., Smith, M.A. & Heise, C.P. J Gastrointest Surg (2012) 16: 1389. doi:10.1007/s11605-012-1861-2

Abstract

Background

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.

Study Design

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 (χ2 tests).

Results

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).

Conclusions

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.

Keywords

Diverticulitis Outpatients Diagnostic techniques and procedures 

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Erin S. O’Connor
    • 1
  • Maureen A. Smith
    • 1
    • 2
    • 3
  • Charles P. Heise
    • 1
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of Family MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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