How to strengthen the management of acute diverticulitis: the utility of the WSES classification—a prospective single-center observational study

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 48; no. 5; pp. 4283 - 4291
• Main Authors: Sebastián-Tomás, Juan Carlos, Gómez-Abril, Segundo Angel, Ripollés, Tomás, Manrique, Andrea, Torres-Sanchez, Teresa, Martínez-Pérez, María Jesús
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2022; Springer Nature B.V
• Subjects: Accuracy; Critical Care Medicine; Decision making; Diverticulitis; Emergency medical care; Emergency Medicine; Intensive; Medicine; Medicine & Public Health; Observational studies; Original Article; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Acute diverticulitis; Computed tomography; Emergency surgery; Classification
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-022-01911-4

Purpose
This study aimed to validate the World Society for Emergent Surgery (WSES) scale for the management of acute left-sided colonic diverticulitis (ALCD).
Methods
An observational study based on a prospective database of patients with ultrasound (US) and computerized tomography (CT) confirmed ALCD was conducted at our center from April 2018 to May 2019. The primary outcome was the success rate of outpatient management. Secondary outcomes were the association between different WSES stages, clinical and analytical parameters, treatments modalities, and outcomes, and the accuracy of US for management decisions.
Results
A total of 230 patients were included. Outpatient management was successful in 51/53 (96.23%) cases with ALCD stage 0 and 62/72 (86.11%) patients with stage 1A. There were no differences in age (
p
 = 0.076) or the presence of pericolic air bubbles (
p
 = 0.06) between patients who underwent admission or outpatient management. Clinical and analytical data, treatment decisions, and outcomes showed statistically significant differences between WSES stages. In 7/12 patients with stage 2A, percutaneous drainage or emergency surgery was required. All cases with stage 2B (distant air) underwent conservative management without the need for emergency or elective surgery. The accuracy of US WSES stages for management decisions, when compared with CT, was 96.96%.
Conclusion
The WSES classification for ALCD seemed to be valid helping clinicians in the decision-making process to select between admission or outpatient management. Differences in clinical and analytical data, elected treatments, and outcomes were found between WSES stages. The US WSES stages showed high accuracy for management decisions.