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Abstract：
Background and purpose Early diagnosis and risk stratification of sigmoid diverticulitis rely heavily on timely imaging. Computerized tomography (CT), the gold standard diagnostic test, may be delayed due to resource constraints or patient comorbidity. Point-of-care ultrasound (POCUS) has an established role in trauma evaluation, and could potentially diagnose and stage acute diverticulitis, thus shortening the time to definitive treatment. Aims This study aimed to benchmark the accuracy of surgeon-performed POCUS against CT in diagnosing and staging acute diverticulitis. A secondary aim was to evaluate the duration between the POCUS and the confirmatory CT scan report. Patients and methods A pragmatic prospective multicenter cohort study (ClinicalTrials.gov Identifier: NCT02682368) was conducted. Surgeons performed point-of-care ultrasound as first-line imaging for suspected acute diverticulitis. POCUS diagnosis and radiologic Hinchey classification were compared to CT as the reference standard. Results Of 45 patients with suspected acute diverticulitis, POCUS classified 37 (82.2%) as uncomplicated diverticulitis, four (8.8%) as complicated diverticulitis, and four (8.8%) as other diagnoses. The POCUS-estimated modified radiologic Hinchey classification was largely concordant with CT staging with an accuracy of 88.8% (95% CI, 75.95-96.2%), a sensitivity of 100% (95% CI, 90.2- 100%) and a specificity of 44.4% (95% CI, 13.7-78.8%). The positive predictive value (PPV) was 87.8% and the negative predictive value (NPV) was 100%. There was moderate agreement between CT and POCUS, with a Cohen\'s kappa coefficient of 0.56. The mean delay between CT and POCUS was 9.14 hours (range 0.33 to 43.5). Conclusion We examined the role of POCUS in the management of acute diverticulitis and our findings suggest that it is a promising imaging modality with the potential to reduce radiation exposure and treatment delays. Adding a POCUS training module to the surgical curriculum could enhance diagnosis and expedite the management of acute diverticulitis.
摘要：
背景与目的乙状结肠憩室炎的早期诊断和危险分层很大程度上依赖于及时的影像学检查。计算机断层扫描（CT），黄金标准诊断测试，可能由于资源限制或患者合并症而延迟。定点护理超声（POCUS）在创伤评估中具有公认的作用，并可能诊断和分期急性憩室炎，从而缩短了确定治疗的时间。目的这项研究旨在使外科医生进行的POCUS相对于CT在诊断和分期急性憩室炎中的准确性成为基准。次要目的是评估POCUS和确认CT扫描报告之间的持续时间。患者和方法进行了一项务实的前瞻性多中心队列研究（ClinicalTrials.govIdentifier：NCT02682368）。外科医生进行了现场护理超声检查，作为疑似急性憩室炎的一线成像。将POCUS诊断和放射学Hinchey分类与CT作为参考标准进行比较。结果45例疑似急性憩室炎患者中,POCUS将37（82.2%）归类为无并发症憩室炎，四个（8.8％）为复杂性憩室炎，和四个（8.8％）作为其他诊断。POCUS估计的改良放射学Hinchey分类与CT分期基本一致，准确率为88.8％（95％CI，75.95-96.2％），敏感性为100%(95%CI,90.2-100%),特异性为44.4%(95%CI,13.7-78.8%)。阳性预测值(PPV)为87.8%,阴性预测值(NPV)为100%。CT和POCUS之间有适度的协议，科恩的卡帕系数为0.56。CT和POCUS之间的平均延迟为9.14小时（范围为0.33至43.5）。结论我们检查了POCUS在急性憩室炎治疗中的作用，我们的发现表明它是一种有前途的成像方式，具有减少辐射暴露和治疗延迟的潜力。在外科课程中添加POCUS培训模块可以增强诊断并加快急性憩室炎的治疗。
