Accuracy of "TICS" ultrasound protocol in detecting simple and complicated diverticulitis: A prospective cohort study.

Autor: Shokoohi H; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Selame LA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Loesche MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Almulhim A; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Al Saud AA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Goldsmith AJ; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Eke OF; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Springer C; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Arru CD; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA., Gullikson J; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., McKaig BN; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Liteplo AS; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Huang CK; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2023 Mar; Vol. 30 (3), pp. 172-179. Date of Electronic Publication: 2022 Dec 12.
DOI: 10.1111/acem.14628
Abstrakt: Background: Point-of-care ultrasound (US) has been suggested as the primary imaging in evaluating patients with suspected diverticulitis. Discrimination between simple and complicated diverticulitis may help to expedite emergent surgical consults and determine the risk of complications. This study aimed to: (1) determine the accuracy of an US protocol (TICS) for diagnosing diverticulitis in the emergency department (ED) setting and (2) assess the ability of TICS to distinguish between simple and complicated diverticulitis.
Methods: Patients with clinically suspected diverticulitis who underwent a diagnostic computed tomography (CT) scan were identified prospectively in the ED. Emergency US faculty and fellows blinded to the CT results performed and interpreted US scans. The presence of simple or complicated diverticulitis was recorded after each US evaluation. The diagnostic ability of the US was compared to CT as the criterion standard. Modified Hinchey classification was used to distinguish between simple and complicated diverticulitis.
Results: A total of 149 patients (55% female, mean ± SD age 58 ± 16 years) were enrolled and included in the final analyses. Diverticulitis was the final diagnosis in 75 of 149 patients (50.3%), of whom 53 had simple diverticulitis and 22 had perforated diverticulitis (29.4%). TICS protocol's test characteristics for simple diverticulitis include a sensitivity of 95% (95% confidence interval [CI] 87%-99%), specificity of 76% (95% CI 65%-86%), positive predictive value of 80% (95% CI 71%-88%), and negative predictive value of 93% (95% CI 84%-98%). TICS protocol correctly identified 12 of 22 patients with complicated diverticulitis (sensitivity 55% [95% CI 32%-76%]) and specificity was 96% (95% CI 91%-99%). Eight of 10 missed diagnoses of complicated diverticulitis were identified as simple diverticulitis, and two were recorded as negative.
Conclusions: In ED patients with suspected diverticulitis, US demonstrated high accuracy in ruling out or diagnosing diverticulitis, but its reliability in differentiating complicated from simple diverticulitis is unsatisfactory.
(© 2022 Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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