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

D. Dante Yeh, Yuchiao Chang, Maryam Bita Tabrizi, Liyang Yu, Catrina Cropano, Peter Fagenholz, David R. King, Haytham M.A. Kaafarani, Marc de Moya, George Velmahos

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number1
DOIs
StatePublished - Jan 2019

Keywords

  • Cholecystitis
  • Cholelithiasis
  • Gallbladder
  • Murphy's sign
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine

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