title: Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score.
abstract: The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score) was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation. The score comprised of: age > 45 years (1 point), heart rate > 90 beats/min (1 point), male (2 points), Leucocytosis > 13,000/mm(3) (1.5 points), and ultrasound gallbladder wall thickness > 4.5 mm (1 point). The prevalence of gangrenous cholecystitis was 13% in the low-probability (0-2 points), 33% in the intermediate-probability (2-4.5 points), and 87% in the high probability category (>4.5 points). A cutoff score of 2 identified 31 (69%) patients with no acute inflammation (PPV 90%). This scoring system can prioritize patients for emergent cholecystectomy based on their expected pathology.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
authors.forename: Wael N
authors.initials: WN
authors.lastname: Yacoub
authors.forename: Mikael
authors.initials: M
authors.lastname: Petrosyan
authors.forename: Indu
authors.initials: I
authors.lastname: Sehgal
authors.forename: Yanling
authors.initials: Y
authors.lastname: Ma
authors.forename: Parakrama
authors.initials: P
authors.lastname: Chandrasoma
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Mason