背景急性憩室炎是一种常见的外科疾病,也是需要住院的主要胃肠道疾病之一。并发症的存在增加了住院时间和需要手术干预的风险。本研究旨在探讨在临床评估中可以识别的临床特征,并评估其在区分复杂性和非复杂性憩室炎中的预测价值和敏感性。方法对LyellMcEwin医院的急性憩室炎患者进行回顾性病例对照研究,阿德莱德,南澳大利亚。收集了2015年1月至2017年12月患者的数据。该研究包括经计算机断层扫描(CT)证实的急性憩室炎患者。报告了多个临床评估方面,并比较了复杂性憩室炎和非复杂性憩室炎组之间的差异。结果共收集116例病例资料,其中10例由于缺乏CT诊断而被排除。44例并发憩室炎(病例组),无并发症憩室炎62例(对照组)。复杂组有23例(52.2%)首次发作憩室炎,而无复杂组有24例(38.7%),赔率比为1.73(0.79-3.789)。复杂组中有8例(18.2%)以前患有憩室炎,而无并发症组中有11例(17.7%)。赔率比为1.03(0.37-2.82)。并发症组有6例(13.6%)发热(T>38),无并发症组有2例(3.2%);赔率比为4.74(0.9-24.7),灵敏度仅为13.64%,特异性为96.77%。12例(27.3%)有心动过速,2例(4.5%)出现低血压,复杂组中有5例(11.4%)的腹膜炎,而2例(3.2%),一例(1.6%),在不复杂的组中有一例(1.6%),赔率比为11.25(2.37-53.4),2.9(0.255-33),和7.82(0.88-69.5),灵敏度分别为27.27%,4.55%,心动过速为11.36%,低血压,和Peritonism,而特异性为96.77%,98.39%,98.39%,分别。结论本研究发现复杂性憩室炎与既往复杂性憩室炎的发作无明显相关性。免疫抑制,疼痛严重程度,或者改变排便习惯.发现直肠出血可降低并发憩室炎的风险。我们的结果没有证明首次憩室炎发作与复杂憩室炎之间存在统计学上的显着关系。体征,当异常时,在预测复杂憩室炎方面具有高度特异性。与其他观察到的体征相比,心动过速被发现具有最高的阳性预测值和优势比。
Background Acute diverticulitis is a common surgical condition and one of the leading gastrointestinal conditions that require hospital admission. The presence of complications increases the hospital stay and risk of requiring surgical intervention. This study aimed to investigate the clinical features that can be identified during clinical assessment and evaluate their predictive value and sensitivity in differentiating between complicated and uncomplicated diverticulitis. Methodology This retrospective case-control study was performed on patients with acute diverticulitis at Lyell McEwin Hospital, Adelaide, South Australia. Data were collected for patients presenting from January 2015 to December 2017. Patients with acute diverticulitis confirmed by computed tomography (CT) were included in the study. Multiple clinical assessment aspects were reported and compared between complicated diverticulitis and uncomplicated diverticulitis groups. Results Data from a total of 116 cases were collected, 10 of which were excluded due to lack of CT diagnosis. Forty-four cases had complicated diverticulitis (case group), and 62 cases had uncomplicated diverticulitis (control group). Twenty-three cases (52.2%) had the first episode of diverticulitis in the complicated group compared to 24 cases (38.7%) in the uncomplicated group, with an odds ratio of 1.73 (0.79-3.789). Eight cases (18.2%) had previously complicated diverticulitis in the complicated group compared to 11 cases (17.7%) in the uncomplicated group, with an odds ratio of 1.03 (0.37-2.82). Six cases (13.6%) had a fever (T > 38) in the complicated group compared to two cases (3.2%) in the uncomplicated group, with an odds ratio of 4.74 (0.9-24.7), a sensitivity of only 13.64%, and a specificity of 96.77%. Twelve cases (27.3%) had tachycardia, two cases (4.5%) had hypotension, and five cases (11.4%) had peritonism in the complicated group compared to two cases (3.2%), one case (1.6%), and one case (1.6%) in the uncomplicated group, with odds ratios of 11.25 (2.37-53.4), 2.9 (0.255-33), and 7.82 (0.88-69.5), respectively; sensitivity was 27.27%, 4.55%, and 11.36% for tachycardia, hypotension, and peritonism, whereas specificity was 96.77%, 98.39%, and 98.39%, respectively. Conclusions The study found no significant correlation between having complicated diverticulitis and previous episodes of complicated diverticulitis, immunosuppression, pain severity, or change in bowel habits. Perrectal bleeding was found to reduce the risk of having complicated diverticulitis. Our results did not demonstrate a statistically significant relationship between the first episode of diverticulitis and having complicated diverticulitis. Physical signs, when abnormal, are highly specific in predicting complicated diverticulitis. Tachycardia was found to have the highest positive predictive value and odds ratio compared to the other observed physical signs.