Ulcerative colitis: clinical features did not help diagnose deep ulceration.

Clinical bottom line (level 4)

Deep ulceration was common in patients with acute colitis.
No clinical signs or symptoms were clearly predictive of deep ulceration.

Buckell et al: Gastroenterology 1980; 79 (1): 19-25

Expires May 2003

The study

Setting: 15 acute hospitals, UK

40 patients (aged ?, ?% male) acute colitis (80% ulcerative colitis, remainder idiopathic) treated with urgent colectomy

Excluded if

evidence of Crohn's disease, infection or ischaemia on histology

Independent ?blinded reference standard, applied in all patients from a consecutive inappropriate spectrum.
Reference standard:

histology: deep ulceration if into or through muscle layer

Diagnostic test: clinical findings

The evidence

pre-test probability of severe ulceration: 62%, (95% CI: 46% to 77%)

diagnostic test	deep ulceration	not deep ulceration	LR+ (95% CI)	post-test probability	LR- (95% CI)	post-test probability
anorexia	16	7	1.6 (0.86 to 2.84)	70%	0.51 (0.22 to 1.17)	43%
abdominal tenderness	20	10	1.33 (0.88 to 2.03)	67%	0.44 (0.15 to 1.33)	40%
fever 37.5°C or more	10	5	1.33 (0.56 to 3.17)	67%	0.85 (0.53 to 1.36)	56%
pulse rate 120/ min or more	10	2	3.33 (0.84 to 13.3)	83%	0.67 (0.45 to 0.98)	50%
white cell count 12,000 or more	11	5	1.38 (0.60 to 3.18)	69%	0.81 (0.49 to 1.36)	57%
albumin 30 g/l or less	14	4	1.91 (0.81 to 4.51)	78%	0.55 (0.28 to 1.08)	50%
total	.	.

Comments

The study is too small to show whether any clinical findings can help identify severe ulceration.

Citation

Buckell NA, Williams GT, Bartram CI, et al: Depth of ulceration in acute colitis: correlation with outcome and clinical and radiologic features. Gastroenterology 1980; 79 (1): 19-25

Search Terms: colit* in Cochrane
Contributor: Chris Ball and Clare Wotton, November 2000
Reviewer:

_{Clinical Question.}

_Patient	_{acute colitis}
_{Intervention or Exposure}	_{signs and symptoms}
_Outcome	_{diagnosis of deep ulceration}