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MINNEAPOLIS – Half of the diverticulitis patients who presented to Minnesota emergency departments and subsequently were admitted to the hospital could have been discharged safely from the ED, a new study suggests.
Background information in the report, published ahead of print by the Journal of the American College of Surgeons, notes that about 150,000 patients are hospitalized each year for the condition involving inflamed pouching in the colon and severe abdominal pain. In addition, the number of patients presenting to EDs with diverticulitis increased 21% from 2006 to 2011, although the admission rate decreased from 55.7% to 48.5%.
Researchers at the University of Minnesota, Minneapolis, found that most patients with uncomplicated diverticulitis could be discharged safely from the ED with antibiotics.
“While that finding may not seem surprising to most surgeons, it is a poorly studied topic in the United States, and gathering some data on this occurrence is important to clarify in terms of whether there are even more people seen in the emergency room who could be safely managed at home,” explained lead author Mary Kwaan, MD, MPH, assistant professor of surgery, division of colon and rectal surgery, department of surgery, University of Minnesota.
As opposed to uncomplicated diverticulitis, which has no identifiable perforation on a CT scan, complicated diverticulitis involves anything from a small perforation of the pouching in the colon to a large perforation of the colon with peritonitis.
This study focused on 240 patients, all of whom had been diagnosed with CT at five hospitals in a Minneapolis health system. Slightly more than half were female with an average age of 59.1 years. Among imaging results were extraluminal air (21%), pericolic or pelvic abscess (12%), free fluid (16%), and pneumoperitoneum (6%).
Of the patients, 144 were admitted to the hospital and 96 were discharged home on oral antibiotics. Admitted patients tended to be older than 65 years of age, to have a Charlson comorbidity score two or greater, to be taking steroids or immunosuppression, and to have extraluminal air or diverticular abscess revealed on imaging.
After median follow-up for all patients of 36.5 months, 12.5% of patients who had been discharged from the ED returned or required readmission within 30 days. One patient required emergency surgery 20 months later.
Readmission rates for the patients admitted to the hospital were not much different, at 15%.
“Patients diagnosed with uncomplicated diverticulitis in the emergency room can be safely discharged home on oral antibiotics, as long as CT findings are included in the decision-making process,” study authors conclude. “Patients with complicated diverticulitis on CT scan should be admitted to the hospital with surgical consultation.”