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Likelihood Ratio (LR) in Emergency Medicine

3/07/2013

Diagnosis of diverticulitis with hands and blood tests. Is it a good idea?


Clinical Scenario

A 66 yo man complains of left lower quadrant (LLQ) abdominal pain from 4/5 hours. The pain is described as crampy initially, than continuous, there is not vomit. Temperature is 37.5°C. Abdomen is treatable, with moderate pain and tenderness localized at LLQ , there is not history of prior abdominal surgery. 
ED US excluded the specter of an AAA.
WBC 13.000/μl
CPR: 51 mg/L

Probably this patient suffers of an acute diverticulitis. 
Is it an urgent imaging necessary to confirm the diagnosis? 














Conclusion 

The patient presented above has a high probability to have an acute non complicated diverticulitis, imaging tests have a little impact on disease’s management. 
Imaging is necessary when all 3 clinical features aren’t present, or when the patient is very ill and the suspect  of any complication is very high. 
On the other hand the absence of any of 3 clinical features isn’t useful to rule out an acute diverticulitis. 


Bibliography 

W.Lameris
A clinical decision rule to establish the diagnosis of acute diverticulitis at the Emergency Department. 
Dis Colon Rectum 2010 53 896-904

JRT Monson
Management of acute diverticulitis: is less more?
Dis Colon Rectum 2011 54 126-128

Ciro Paolillo

to be continued...

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