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2007 Program and Abstracts | 2007 Posters
Does a 48-Hour Rule Predict Outcomes in Patients with Acute Diverticulitis?
Jessica Evans*1,2, Alexandra Lukianoff1, Anthony Voytovich1, Jennifer Lardner1, William Pennoyer2, Wayne Frederick1, Robert Kozol1
1Surgery, University of Connecticut Health Center, Farmington, CT; 2Surgery, St. Francis Hospital, Hartford, CT

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


2007 Program and Abstracts | 2007 Posters
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