brand logo

Am Fam Physician. 2024;110(3):online

CLINICAL QUESTION

What are the most accurate tests available in the primary care setting for diagnosing acute diverticulitis?

BOTTOM LINE

Point-of-care ultrasonography is increasingly finding a role at the bedside, and this study adds to that evidence base. In a patient with acute abdominal pain, point-of-care ultrasonography has been shown to be highly accurate for the diagnosis of appendicitis, small bowel obstruction, aneurysm, and now, acute diverticulitis. (Level of Evidence = 2a)

SYNOPSIS

The meta-analysis identified 15 prospective and two retrospective studies of the diagnosis of acute diverticulitis using signs, symptoms, and tests that are feasible in the primary care setting (none of the studies were done in the primary care setting). Only four studies reported data regarding signs and symptoms, and the two studies that evaluated the same sign or symptom had different sensitivity and specificity measures. Overall, the authors concluded that individual signs and symptoms are of uncertain value. A white blood cell count greater than 10 per μL (0.01 × 109 per L) was not helpful (positive likelihood ratio [LR+] = 1.6; negative likelihood ratio [LR–] = 0.56). Three studies reported C-reactive protein (CRP) levels greater than 1.0 mg per dL (10 mg per L) and all reported excellent sensitivity (89% to 96%) but variable specificity. This means that a negative or normal CRP level is helpful for ruling out acute diverticulitis, but an abnormal value is not helpful (pooled sensitivity = 93%; 95% CI, 0.87 to 0.96; pooled LR– = 0.17; 95% CI, 0.05 to 0.43). The most accurate and best-studied test is ultrasonography (sensitivity 92%; specificity 94%; LR+ = 15.3; and LR– = 0.08). Point-of-care ultrasonography was as accurate as ultrasonography performed in the radiology department.

Already a member/subscriber?  Log In

Subscribe

From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/Home/Loe?show=Sort.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading

More in AFP

Copyright © 2024 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.