Derivation and validation of a practical Bedside Score for the diagnosis of cholecystitis.
Am J Emerg Med
; 37(1): 61-66, 2019 01.
Article
em En
| MEDLINE
| ID: mdl-29724580
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Cálculos Biliares
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Sistemas Automatizados de Assistência Junto ao Leito
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Colecistite Aguda
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Técnicas de Diagnóstico do Sistema Digestório
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Serviço Hospitalar de Emergência
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article