Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department

Abstract

We aim to develop a diagnostic score for acute cholecystitis that integrates symptoms, physical examinations, and laboratory data to help clinicians for timely detection and early treatment of this disease. We retrospectively collected data from our database from 2010 to 2020. Patients with acute abdominal pain who underwent an ultrasound or computed tomography (CT) scan at the emergency department (ED) were included. Cases were identified by pathological, CT, or ultrasound reports. Non-cases were those who did not fulfill any of these criteria. Multivariable regression analysis was conducted to identify predictors of acute cholecystitis. The model included 244 patients suspected of acute cholecystitis. Eighty-six patients (35.2%) were acute cholecystitis confirmed cases. Five final predictors remained within the reduced logistic model: age < 60, nausea and/or vomiting, right upper quadrant pain, positive Murphy’s sign, and AST ≥ two times upper limit of normal. A practical score diagnostic performance was AuROC 0.74 (95% CI, 0.67–0.81). Patients were categorized with a high probability of acute cholecystitis at score points of 9–12 with a positive likelihood ratio of 3.79 (95% CI, 1.68–8.94). ED Chole Score from these five predictors may aid in diagnosing acute cholecystitis at ED. Patients with an ED Chole Score >8 should be further investigated.

Clinical Utility of the Tokyo Guidelines 2018 for Acute Cholangitis in the Emergency Department and Comparison with Novel Markers (Neutrophil-to-Lymphocyte and Blood Nitrogen Urea-to-Albumin Ratios)

“…In an ED-based setting, where efficiency and practicality are highly desired, clinicians may find the application of various parameters challenging [8]. Generally, emergency physicians are essential for providing quick and effective care in a variety of emergencies [8,9]. However, limited resources must be utilized efficiently to provide optimal care in emergency settings [10].…”

“…9 /L) 193,000(13,000-523,000) Albumin (g/dL) 4.1 (1.2-5.2) Total bilirubin (mg/dL) 2.2 (0.2-23.5) PT-INR 1.1 (0.86-3.27) BUN (mg/dL) 15.55 (4.5-200)…”

Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency service

“…Secondary signs of acute cholecystitis include mural thickening greater than 3 mm, stratification, distension, or hydropic gallbladder, and pericholecystic fluid. 21 Elevated white blood cell (WBC) count 22 and symptoms such as nausea and vomiting may also be present. 23…”

“…Secondary signs of acute cholecystitis include mural thickening greater than 3 mm, stratification, distension, or hydropic gallbladder, and pericholecystic fluid. 21 Elevated white blood cell (WBC) count 22 and symptoms such as nausea and vomiting may also be present. 23 Patients presenting with a wide range of conditions and severity levels may present to this peripheral emergency department (ED) in Southern Portugal, which faces limitations in diagnostic technology and the absence of radiologists.…”