David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Factors supporting a diagnosis of diverticulitis include age older than 50 years, pain or tenderness in the left lower quadrant, exacerbation of pain with movement, absence of vomiting, temperature of 38.5° C or higher, history of diverticulitis, and C-reactive protein level of 50 mg/L or higher. Scoring nomograms using these features can be highly specific but generally lack sensitivity.
Computed tomography scanning with intravenous and luminal contrast is the imaging test of choice for diagnosing diverticulitis, with sensitivity and specificity of 95% and 96%, respectively. Alternative imaging modalities include ultrasonography (operator dependent, lower sensitivity and specificity) and magnetic resonance (highly sensitive and specific).
In the acute setting, a surgeon should be consulted in cases of larger abscesses (larger than 3 cm), peritonitis, severe symptoms, failure to improve with medical therapy, and when diverticulitis is accompanied by bowel obstruction or fistula.
All patients with an incident episode of acute diverticulitis should be referred for colonoscopy 4 to 8 weeks after resolution of the acute illness to rule out other pathologic conditions, such as colon cancer or inflammatory bowel disease.
The authors conclude that the Medicare-reported readmission rates for patients admitted with heart failure, myocardial infarction, or pneumonia do not correspond closely with readmission rates in the other groups and may not be good surrogates for overall hospital quality, as related to readmissions.
An accompanying editorial points out that the readmission rates for Medicare patients with these 3 conditions were never intended to represent the overall readmission performance of a given hospital, and that a hospital-wide readmission metric already exists (although currently not used to assess financial penalties) that may more accurately reflect the overall readmission performance of hospitals.
Wesorick DH, Chopra V. Annals for Hospitalists - 15 May 2018. Ann Intern Med. 2018;168:HO1. doi: https://doi.org/10.7326/AFHO201805150
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Published: Ann Intern Med. 2018;168(10):HO1.
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