Derivation and validation of a practical Bedside Score for the diagnosis of cholecystitis

We sought to develop a practical Bedside Score for the diagnosis of cholecystitis and test its accuracy against the Tokyo Guidelines (TG13). We conducted a retrospective study of 438 patients undergoing urban, academic Emergency Department (ED) evaluation of RUQ pain. Symptoms, physical signs, ultra...

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Bibliographic Details
Published in:The American journal of emergency medicine 2019-01, Vol.37 (1), p.61-66
Main Authors: Yeh, D. Dante, Chang, Yuchiao, Tabrizi, Maryam Bita, Yu, Liyang, Cropano, Catrina, Fagenholz, Peter, King, David R., Kaafarani, Haytham M.A., de Moya, Marc, Velmahos, George
Format: Article
Language:English
Subjects:
Abdomen
Accuracy
Calculi
Cholecystectomy
Cholecystitis
Cholelithiasis
Data processing
Diagnosis
Emergency medical care
Emergency medical services
Fever
Gallbladder
Gallbladder diseases
Hospitals
Medical diagnosis
Medical imaging
Murphy's sign
Pain
Patients
Regression analysis
Surgeons
Ultrasonic imaging
Ultrasound
Vomiting
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Summary:We sought to develop a practical Bedside Score for the diagnosis of cholecystitis and test its accuracy against the Tokyo Guidelines (TG13). We conducted a retrospective study of 438 patients undergoing urban, academic Emergency Department (ED) evaluation of RUQ pain. Symptoms, physical signs, ultrasound signs, and labs were scoring system candidates. A random split-sample approach was used to develop and validate a new clinical score. Multivariable regression analysis using development data was conducted to identify predictors of cholecystitis. Cutoff values were chosen to ensure positive/negative predictive values (PPV, NPV) of at least 0.95. The score was externally validated in 80 patients at a different hospital undergoing RUQ pain evaluation. 230 patients (53%) had cholecystitis. Five variables predicted cholecystitis and were included in the scores: gallstones, gallbladder thickening, clinical or ultrasonographic Murphy's sign, RUQ tenderness, and post-prandial symptoms. A clinical prediction score was developed. When dichotomized at 4, overall accuracy for acute cholecystitis was 90% for the development cohort, 82% and 86% for the internal and external validation cohorts; TG13 accuracy was 62%–79%. A clinical prediction score for cholecystitis demonstrates accuracy equivalent to TG13. Use of this score may streamline work-up by decreasing the need for comprehensive ultrasound evaluation and CRP measurement and may shorten ED length of stay.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2018.04.051