title: Limiting stochastic harm when monitoring diverticular flogosis for lower Hinchey classes. Personal proposal for a selection method Reliability Ultrasound Score (RUS).
abstract: BACKGROUND
  An article in the BMJ issueof May 2012 (11) tackled the issue of safeguarding health by preventing diagnostic overtreatment. An observation of the diagnostic options in clinical routine enabled us to critically assess the appropriateness or notof the use of ionising radiation in monitoring acute diverticulitis by means of CT imaging. This disease, which has alwaysbeen frequent in elderly patients, has recently assumed a new role as an endemicdiseasein the Caucasian populationaged 40 to 50 in the Western world (6).
  
  
  METHODS
  We considered 79 cases coming under observation in the Emergency Roomover a period of 115 months, selected from a pool of 136 according to Hinchey Score (Hs) 0-1a-1b- assigned on admission after an Ultrasound(US) examination . The choice of the first diagnostic approach depended on the severity of the patient 's clinical condition, the degree of collaboration of the same and the discretion of the radiologist, although the concerted opinion was to prefer the US test given its clearly- established advantages of being convenient and harmless. During the period of recovery we noted the tendency to subordinate the choice of instrument to the habit and discretion of the attending practitioner. Our proposal was to introduce a standardised personal criterion which took into account the problem of stochastic harm from ionising radiation. The need of exposure or not to verify the clinical condition by means of a CT as opposed to a US was thus deduced by means of an Reliability Ultrasound Score (RUS) RESULTS: Using such score we were able to schedule in 14 out of the 37 cases in one branch of the study, an effective diagnostic check-up programmein safety and with an overall saving of 32 % of the ionising radiation. During this study wequantified a total amount of miniSivertnot dispensed, in 79 cases with Hs<2deserving of hospital admission.
  
  
  CONCLUSIONS
  This choice moves in the direction of safeguarding the patient fromdiagnostic overtreatment,with a potential increase in stochastic harm. The application of a reliability assessment filterof the US examination is currently in the study phase as regards acute diverticular disease in classesHS=/>2°.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Caputo
authors.forename: Marco
authors.initials: M
authors.lastname: Rovagnati
authors.forename: Hamid
authors.initials: H
authors.lastname: Pakrawanan
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Carzaniga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013269:Stochastic Processes; D018608:Ultrasonography, Doppler / Q000379:methods