Tan et al reported factors associated with severe acute diverticulitis. These can help to identify a patient who may require more aggressive management. The authors are from the University of Auckland, Lower Hurt Hospital and Middelmore Hospital in New Zealand.
Patient selection: diverticulitis
Predictors of severe diverticulitis:
(1) first episode of diverticulitis
(2) Charlson comorbidity index >= 3
(3) use of non-steroidal anti-inflammatory agents (NSAIDs)
(4) steroid therapy
(5) high serum CRP on admission
(6) severe disease on CT (abscess, extraluminal air, extraluminal contrast, etc)
A CRP < 50 mg/L usually rules out perforation.
A CRP > 150 mg/L usually is associated with complicated diverticulitis.
A patient with low risk may be able to be treated with oral antibiotics as an outpatient.
