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More A&E patients can ‘avoid admission for diverticulitis’

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More patients currently admitted with diverticulitis – an inflammation of an outgrowth or pouching in the colon that can cause severe abdominal pain – could be sent home, suggest US researchers.

A study of patients with diverticulitis who went to accident and emergency has concluded that about half of those admitted could have been sent home with a prescription and treatment advice.

“Unnecessary hospital admissions cost the system”

Mary Kwaan

Researchers said most patients with uncomplicated diverticulitis could safely go home from A&E with a prescription for oral antibiotics, and with a very low risk of returning to hospital.

Complicated diverticulitis involves a small perforation of the pouching or outgrowth of the colon that is visible on a computerised tomography (CT) scan, whereas uncomplicated diverticulitis is defined as no identifiable perforation on a CT scan.

Extreme cases involve a large perforation of the colon with peritonitis, which is inflammation of the abdomen. The goal of treatment is to relieve symptoms, typically of abdominal pain and inflammation, and to restore normal bowel function.

Severe cases often require surgery and CT scanning is essential in the diagnosis of diverticulitis.

The researchers evaluated 240 patients treated in five hospital A&Es, of which 60% were admitted to hospital and 40% were discharged to their homes on oral antibiotics.

Admitted patients were more likely to be age 65 years or older, have other health problems, take steroids to treat inflammation or agents that suppressed their immune system, have excess air in the digestive system, or have an abscess or perforation in the diverticular area, as seen on a CT scan.

Among those patients discharged from the emergency room, 12.5% returned to A&E or were admitted to the hospital within 30 days, and only one patient required emergency surgery, but not until 20 months later.

The study authors found that 53% of the admitted patients in their study could be safely discharged home.

Two key factors the researchers found that determined the severity of diverticulitis were high fever and high white blood cell counts. Among low-risk patients, few had high fevers and most had normal or mildly elevated white blood cell counts.

University of Minnesota

More A&E patients can ‘avoid admission for diverticulitis’

Mary Kwaan

While the researchers acknowledged that the study was relatively small, they argued it was significant because it involved several A&E departments across one healthcare system.

It also confirmed findings of an earlier randomised trial in Spain that concluded outpatient treatment was safe in selected cases of uncomplicated diverticulitis, they added in the Journal of the American College of Surgeons.

Lead study author Mary Kwaan, assistant professor of surgery at the University of Minnesota, said hospitals could use the study findings to develop protocols for A&E to better treat diverticulitis.

“Diverticulitis is quite a common disease, and there is a general movement among hospitals toward being more strategic with their resources,” said Dr Kwaan. “Unnecessary hospital admissions cost the system and potentially expose patients to hospital-acquired infections.”

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