Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making
Article first published online: 26 JAN 2009
© 2010 The Authors. Journal Compilation © 2010 The Association of Coloproctology of Great Britain and Ireland
Volume 12, Issue 3, pages 179–186, March 2010
How to Cite
Toorenvliet, B. R., Bakker, R. F. R., Breslau, P. J., Merkus, J. W. S. and Hamming, J. F. (2010), Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making. Colorectal Disease, 12: 179–186. doi: 10.1111/j.1463-1318.2009.01778.x
- Issue published online: 17 FEB 2010
- Article first published online: 26 JAN 2009
- Received 11 August 2008; accepted 27 October 2008
- computed tomography;
Objective To evaluate the diagnostic accuracy of clinical evaluation and cross-sectional imaging modalities such as ultrasound and computed tomography for patients with suspected colonic diverticulitis and to determine the value of these examinations in clinical decision-making.
Method A prospective analysis was conducted of 802 consecutive patients that presented with abdominal pain at the emergency department. Initial clinical diagnoses and management proposals were compared to the final diagnoses and therapeutic strategies for all patients.
Results Fifty-seven patients were identified with colonic diverticulitis as the final diagnosis. The positive and negative predictive values for the clinical diagnosis of colonic diverticulitis were 0.65 and 0.98 respectively. Additional cross-sectional imaging had a positive and negative predictive value of respectively 0.95 and 0.99 or higher. These additional examinations led to a correct change of the initial clinical diagnosis in 37% of the patients, and a change in management in only 7%.
Conclusion The accuracy of the clinical diagnosis for colonic diverticulitis is low. Ultrasound and computed tomography have superior diagnostic accuracy but these examinations rarely change the initial management proposal.