Reduction in hospital admissions with an early computed tomography scan: results of an outpatient management protocol for uncomplicated acute diverticulitis. Issue 9 (17th June 2019)

• Record Type: Journal Article
• Authors: Juszczyk, Karolina; Ireland, Kelsey; Thomas, Bev; Kroon, Hidde M.; Hollington, Paul
• Is Part Of: ANZ journal of surgery. Volume 89:Issue 9(2019)
• Page Start: 1085
• Page End: 1090
• Publication Date: 2019-06-17
• Subjects: ambulatory care -- diverticulitis -- healthcare costs -- oral antibiotics -- outpatients; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.15285
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract : 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.