title: The use of the modified Neff classification in the management of acute diverticulitis.
abstract: BACKGROUND
  Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management.
  
  
  OBJECTIVE
  To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD.
  
  
  METHODS
  Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery.
  
  
  RESULTS
  The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered: 271 women and 319 men, with a median age of 60 years (range: 25-92 years). mNeff grades were as follows: grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%): 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%): five surgery and two drainage. Grade II (30, 5.2%): ten surgery and four drainage. Grade III (5, 0.9%): one surgery and one drainage. Grade IV (34, 5.9%): ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage.
  
  
  CONCLUSIONS
  The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD.
authors.affiliation: Servicio de Cirugía General, Hospital Universitari Parc Taulí, ESPAÑA.
authors.forename: Laura
authors.initials: L
authors.lastname: Mora López
authors.affiliation: Cirugía General, Parc Taulí Sabadell. Hospital Universitari, España.
authors.forename: Roser
authors.initials: R
authors.lastname: Flores Clotet
authors.affiliation: Servicio de Cirugía General, Hospital Universitari Parc Tauli, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Serra Aracil
authors.affiliation: Servicio de Cirugía General , Hospital Universitari Parc Tauli, España.
authors.forename: Noemí
authors.initials: N
authors.lastname: Montes Ortega
authors.affiliation: Servicio de Cirugía General, Hospital Universitari Parc Tauli, España.
authors.forename: Salvador
authors.initials: S
authors.lastname: Navarro Soto
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004239:Diverticulitis, Colonic / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome