Journal Article

Acute Diverticulitis: Identifying Patients Unlikely to Have Complications

Ebell, Mark H., MD, MS

2020

Overview

A systematic review identified 12 studies, including a total of 4,619 patients, that evaluated risk factors for complicated diverticulitis.5 The authors concluded that individual risk factors include increasing age, diffuse rather than localized abdominal pain, guarding or rebound pain, initial episode of diverticulitis, steroid use, fever, constipation, vomiting, elevated C-reactive protein (CRP) level, and elevated white blood cell (WBC) count. Using a cutoff of 17 mg per dL (170 mg per L), 91% with nonsevere diverticulitis had a CRP level below that cutoff compared with only 12.5% of those with complicated disease (91% sensitive and 87.5% specific for the diagnosis of nonsevere diverticulitis).6 A second study of 99 consecutive patients, all of whom underwent computed tomography, found a sensitivity of 90.9% and specificity of 90.9% using a similar cutoff of 17.3 mg per dL (173 mg per L).7 Finally, Bolkenstein and colleagues developed and validated a simple clinical risk score (Table 1) to determine the likelihood of complicated diverticulitis, defined as the presence of abscess or peritonitis and requiring intervention.8 They used data from 950 patients with acute diverticulitis, randomly dividing the patients into a derivation group, which was used to develop the risk score through multivariate analysis, and a validation group; both groups included 475 patients. Clinical Risk Score for Complicated Diverticulitis Clinical variable Points Abdominal guarding Absent 0 Present 4 White blood cell count; per μL (× 109 per L) ≤ 15,000 (15.0) 0 15,100 to 20,000 (15.1 to 20.0) 1 > 20,000 (20.0) 2 C-reactive protein; mg per dL (mg per L) ≤ 10 (100) 0 10.1 to 15 (101 to 150) 3 15.1 to 20 (151 to 200) 4 20.1 to 25 (201 to 250) 5 > 25 (250) 7 Total: Total points Risk of complicated diverticulitis (%) 0 4.2 1 6.8 2 10.7 3 16.6 4 24.7 5 35 6 47.1 7 59.5 8 70.7 9 79.9 10 to 13 > 85 Adapted with permission from Bolkenstein HE, van de Wall BJ, Consten ECJ, et al.

• Publisher: American Academy of Family Physicians
• Subject: Abdomen / Abdominal Pain - physiopathology / Abscess - diagnosis / Abscess - metabolism / Abscess - physiopathology / Abscesses / Age Factors / C-reactive protein / C-Reactive Protein - metabolism / Clinical Decision Rules / Complications and side effects / Constipation - physiopathology / Diverticulitis / Diverticulitis - diagnosis / Diverticulitis - metabolism / Diverticulitis - physiopathology / Diverticulitis, Colonic - diagnosis / Diverticulitis, Colonic - metabolism / Diverticulitis, Colonic - physiopathology / Evidence-based medicine / Family Medicine/General Medicine / Fever - physiopathology / Humans / Internal Medicine / Leukocyte Count / Pain / Patients / Peritonitis / Peritonitis - diagnosis / Peritonitis - metabolism / Peritonitis - physiopathology / Risk Assessment / Systematic review / Vomiting - physiopathology