INTRO: Sigmoid diverticulitis is an infection that resolves with conservative management in 75-90% of patients. Some require prolonged hospitalization or surgery during their admission. It has been taught that clinical improvement at 48 hours may predict resolution without surgery. In this study, we examined whether basic clinical parameters (the Tmax and WBC) of patients would predict early discharge or prolonged hospitalization.
Methods: Data was acquired from 198 patients admitted with acute sigmoid diverticulitis as confirmed by CT scanning and physical exam. 165 patients recovered without surgery: 120 were discharged within 4 days, while 45 patients required longer stays. 19 patients underwent surgery early during their admission (within 48 hours). 14 patients did not improve over time and required surgery during this hospital stay. The daily Tmax and WBC of patients with prolonged stays or surgery was compared to the patients who were discharged within 4 days using ANOVA analysis.
Results: The table below compares the early discharge group with the patients requiring a prolonged stay and/or surgery.The Tmax and WBC on admission were not statistically different between the groups (p=0.66, p=0.74 respectively). Therefore Tmax and WBC on admission alone are not predictive. After the first 24 hours, however, one could see a statistically significant difference in Tmax (p=0.004). The WBC responded significantly by hospital day 2 (p=0.003). Both trends were significant through hospital day 4.

Discussion: Patients with a noticeable drop in WBC and Tmax over the first 48 hours of medical management were predictably successfully discharged early on oral antibiotics. Patients failing to improve at 48 hrs required prolonged stays or surgery.
Conclusion: By closely observing WBC and Tmax in patients with diverticulitis, one can predict whether they will recover after a brief hospital stay, or if they will likely require prolonged IV antibiotics and/or surgery.
Early Discharge Pts vs Extended Stay Pts (ANOVA)

		Sum of Squares	df	Mean Square	F	Sig.
WBC 1 (24 hours)	Between Groups	56.171	1	56.171	2.950	0.088
	Within Groups	3084.353	162	19.039
	Total	3140.524	163
WBC 2 (48 hours)	Between Groups	132.712	1	132.712	9.048	0.003
	Within Groups	1892.201	129	14.668
	Total	2024.913	130
Temp 1 (24 hours)	Between Groups	11.332	1	11.332	8.491	0.004
	Within Groups	257.557	193	1.334
	Total	268.889	194
Temp 2 (48 hours)	Between Groups	17.587	1	17.587	8.486	0.004
	Within Groups	385.490	186	2.073
	Total	403.077	187