Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis.
OBJECTIVE
The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain.


METHODS
The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain.


RESULTS
Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages <65 years, AUC = 0.86 (CI 0.78 to 0.93) in older patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively.


CONCLUSIONS
This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.
Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7602, Levanger, Norway.|Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Jamal Talabani
Clinic of Surgery, St Olavs Hospital, University of Trondheim, Trondheim, Norway.|Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Endreseth
Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Lydersen
Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7602, Levanger, Norway. thedna@hnt.no.|Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. thedna@hnt.no.
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http://orcid.org/0000-0002-9948-0627
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Edna
D015746:Abdominal Pain / Q000097:blood / Q000150:complications*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000378:metabolism; D004239:Diverticulitis, Colonic / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D013696:Temperature
D002097:C-Reactive Protein
Acute colonic diverticulitis; C-reactive protein; Clinical diagnostic accuracy; Receiver operating characteristic curve; Temperature; White blood cell count