Development and validation of algorithms to identify acute diverticulitis

Kawatkar, Aniket A.; Chu, Li-Hao; Iyer, Rajan L.; Yen, Linnette; Chen, Wansu; Erder, M. Haim; Hodgkins, Paul; Longstreth, George F.

doi:10.1002/pds.3708

Cited by 9 publications

(9 citation statements)

References 19 publications

(37 reference statements)

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“…Strengths of the study include large cohorts with validated methods of identifying physician-diagnosed IBS 14 and diverticulitis 15 that were assessed for a median of at least 10 years. We utilized comprehensive databases in a prepaid health care system, double-physician record review and objective evidence for revised diagnoses and exclusion of diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

“…Testing the method in 1502 randomly selected KPSC members revealed a sensitivity of 84.6% and positive predictive value of 98.1% for physician-diagnosed diverticulitis in outpatients. 15 As we assessed only clinically diagnosed diverticulitis, we excluded patients who had undergone computed tomography (CT) of the abdomen and/or pelvis with or without oral contrast ≤ 14 days before diagnosis, identified by Current Procedural Terminology codes 74176 to 74178, 74150, 74160, and 74170. We assessed the frequency of outpatient, clinically diagnosed, antibiotic-treated diverticulitis diagnosis from January 1, 2003 to December 31, 2017.…”

Section: Identification Of Diverticulitismentioning

confidence: 99%

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Misdiagnosis of Diverticulitis After a Prior Diagnosis of Irritable Bowel Syndrome (IBS)

2020

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Introduction: Irritable bowel syndrome (IBS) and diverticulitis share clinical features. Misdiagnosed diverticulitis can cause unnecessary antibiotic therapy. Among IBS and non-IBS patients, we compared outpatient, clinically diagnosed (no computed tomography) diverticulitis rates. Among primary-care, diverticulitis-diagnosed IBS patients, we assessed imaged diverticulosis and probable misdiagnosed diverticulitis. Methods: Among 3836-patient IBS and 67,827-patient non-IBS cohorts identified from 2000 to 2002, we retrospectively compared the frequency of outpatient, clinically diagnosed, antibiotic-treated diverticulitis from 2003 to endpoints of December 31, 2017, disenrollment, or death. In IBS patients, we reviewed records of initial, primary care-managed episodes for misdiagnosis. Results: In 3836 clinically diagnosed IBS and 63,991 non-IBS cohorts, followup (median [interquartile range]) was 12.4 (3.9 to 15.0) years versus 10.2 (3.0 to 15.0) years, respectively (P < .001). The incidence rate/1000 patient-years (95% CI) of diagnosed diverticulitis was 14.0 (12.1 to 16.3) and 4.2 (4.0 to 4.5), respectively, (crude incidence rate ratio, 3.3 [2.8-3.9]; P <. 001). Of examined features, the diagnosis of IBS was most strongly associated with clinically diagnosed diverticulitis (adjusted incidence rate ratio [95% CI]; 2.64 [2.21-3.15], P < .001). Of initial diverticulitis diagnoses in 189 IBS patients, objective evidence-based diagnosis revision or exclusion occurred in 12 (6.3%), including 6 hospitalized; 29 (15.3%) had colon imaging before and/or afterward without diverticulosis reported; 143 (75.1%) had image-documented diverticulosis; and 6 (3.2%) had no imaging. Conclusions: Outpatient, clinically diagnosed, antibiotic-treated diverticulitis was increased 3-fold in IBS patients. Primary care clinical misdiagnosis of initial episodes occurred in 1 of 5 patients, but additional misdiagnosis due to misattribution of IBS pain to diverticulitis is suggested.

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Section: Discussionmentioning

confidence: 99%

Section: Identification Of Diverticulitismentioning

confidence: 99%

Misdiagnosis of Diverticulitis After a Prior Diagnosis of Irritable Bowel Syndrome (IBS)

2020

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“…), as has been done in previous studies. 32 Abstractors performed overlapping coding of 10% of the records, resulting in 100% concordance.…”

Section: Methodsmentioning

confidence: 99%

The Association Between Family History and Diverticulitis Recurrence: A Population-Based Study

Horns

Hanson

Allen‐Brady

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…1, we identified 33,128 patients at least 18 years of age who had ICD-9-CM code 562.11 for diverticulitis and a pharmacy dispensing record of an antibiotic within 7 days after diagnosis from January 1, 2010, to December 31, 2013. Validation of case finding in the KPMCP based on ICD-9-CM coding and a pharmacy record of an antibiotic dispensed within 7 days after diagnosis compared with manual record review revealed sensitivities and positive predictive values for outpatient, emergency department, and inpatient settings of 84.6 and 98.2 %, 95.8 and 98.1 %, and 91.8 and 82.6 %, respectively [23]. For patients with multiple episodes, the most recently coded one was considered the index episode.…”

Section: Study Populationmentioning

confidence: 98%

Clinically Diagnosed Acute Diverticulitis in Outpatients: Misdiagnosis in Patients with Irritable Bowel Syndrome

Longstreth

Tieu

2015

Dig Dis Sci

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Development and validation of algorithms to identify acute diverticulitis

Abstract: Using antibiotic prescriptions to supplement diagnostic codes improved the accuracy of case identification for diverticulitis, but results varied by care setting.

Cited by 9 publications

References 19 publications

Misdiagnosis of Diverticulitis After a Prior Diagnosis of Irritable Bowel Syndrome (IBS)

Misdiagnosis of Diverticulitis After a Prior Diagnosis of Irritable Bowel Syndrome (IBS)

The Association Between Family History and Diverticulitis Recurrence: A Population-Based Study

Clinically Diagnosed Acute Diverticulitis in Outpatients: Misdiagnosis in Patients with Irritable Bowel Syndrome

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