Abstract
Objective
We sought to develop a practical Bedside Score for the diagnosis of cholecystitis
and test its accuracy against the Tokyo Guidelines (TG13).
Methods
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.
Results
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%.
Conclusions
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.
Keywords
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Article Info
Publication History
Published online: April 24, 2018
Accepted:
April 23,
2018
Received in revised form:
April 20,
2018
Received:
August 23,
2017
Footnotes
☆None of the authors report any conflicts of interest.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
