Reduction in hospital admissions with an early computed tomography scan: results of an outpatient management protocol for uncomplicated acute diverticulitis.
Acute Disease
Adult
Aged
Aged, 80 and over
Ambulatory Surgical Procedures
Clinical Protocols
Diverticulitis, Colonic
/ diagnostic imaging
Early Diagnosis
Emergency Service, Hospital
Female
Hospitalization
/ statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
Young Adult
ambulatory care
diverticulitis
healthcare costs
oral antibiotics
outpatients
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
26
12
2018
revised:
10
04
2019
accepted:
14
04
2019
pubmed:
18
6
2019
medline:
2
10
2020
entrez:
18
6
2019
Statut:
ppublish
Résumé
There is increasing evidence that uncomplicated acute diverticulitis (UAD) can be safely and effectively managed as an outpatient. The aim of the current study was to evaluate if an early computed tomography (CT) scan in the emergency department (ED) can reduce the number of hospital admissions when UAD is diagnosed, without compromising patient safety. A protocol was introduced in 2015, whereby patients with suspected diverticulitis receive a CT scan on presentation to the ED and be considered for discharge home on oral antibiotics if UAD is confirmed. A retrospective analysis of a prospectively collected database was conducted for all patients presenting to the ED with acute diverticulitis over a 4-year period: 2 years prior (May 2013-April 2015; pre-protocol) and 2 years after implementation of the protocol (May 2015-April 2017; post-protocol). A total of 1147 patients presented to the ED, who were diagnosed with diverticulitis, and UAD was confirmed in 552 patients. There was a significant decrease in hospital admissions for UAD in the post-protocol group from 93% to 39% (P < 0.0001) and in the total number of hospital admission days from 602 to 370 (P < 0.0001). There was no increase in representations between both periods (7% versus 6%; P = 0.49). Definitive diagnosis by early CT scan in the ED decreased the admission rate for UAD by more than 50%, and significantly reduced the total number of hospital days without resulting in an increase in representations. UAD can safely and effectively be treated in an outpatient setting leading to a reduction in the burden on the health system.
Sections du résumé
BACKGROUND
There is increasing evidence that uncomplicated acute diverticulitis (UAD) can be safely and effectively managed as an outpatient. The aim of the current study was to evaluate if an early computed tomography (CT) scan in the emergency department (ED) can reduce the number of hospital admissions when UAD is diagnosed, without compromising patient safety.
METHODS
A protocol was introduced in 2015, whereby patients with suspected diverticulitis receive a CT scan on presentation to the ED and be considered for discharge home on oral antibiotics if UAD is confirmed. A retrospective analysis of a prospectively collected database was conducted for all patients presenting to the ED with acute diverticulitis over a 4-year period: 2 years prior (May 2013-April 2015; pre-protocol) and 2 years after implementation of the protocol (May 2015-April 2017; post-protocol).
RESULTS
A total of 1147 patients presented to the ED, who were diagnosed with diverticulitis, and UAD was confirmed in 552 patients. There was a significant decrease in hospital admissions for UAD in the post-protocol group from 93% to 39% (P < 0.0001) and in the total number of hospital admission days from 602 to 370 (P < 0.0001). There was no increase in representations between both periods (7% versus 6%; P = 0.49).
CONCLUSION
Definitive diagnosis by early CT scan in the ED decreased the admission rate for UAD by more than 50%, and significantly reduced the total number of hospital days without resulting in an increase in representations. UAD can safely and effectively be treated in an outpatient setting leading to a reduction in the burden on the health system.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1085-1090Informations de copyright
© 2019 Royal Australasian College of Surgeons.
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