title: A proposal for a preoperative clinical scoring system for acute cholecystitis.
abstract: BACKGROUND
  Acute cholecystitis is a common diagnosis for which surgery is usually indicated. However, the heterogeneity of clinical presentation makes it difficult to standardize management. The variation in clinical presentation is influenced by both patient-dependent and disease-specific factors. A preoperative clinical scoring system designed to included patient-dependent and clinical factors might be a useful tool in clinical decision making.
  
  
  METHODS
  The data of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a university hospital were retrospectively reviewed. Patient-dependent factors (age, sex, body mass index, and American Society of Anesthesiologists score) and disease-specific factors (history of biliary colics, white blood count, C-reactive protein, and gallbladder wall thickness) were used to compute a clinical score between zero and nine for each patient. Cholecystitis was classified as mild (score ≤ 3), moderate (4 ≤ score ≤ 6), or severe (score ≥ 7).
  
  
  RESULTS
  Cholecystitis was mild in 45 cases, moderate in 105 cases, and severe in 27 cases. Among patient-dependent factors, the male gender, age >65 y, and American Society of Anesthesiologists score >2 correlated significantly with high scores, P = 0.001. Equally, high white blood count, elevated C-reactive protein, and gallbladder wall thickness >4 mm correlated significantly with high scores, P = 0.001. These findings were confirmed on multivariate analyses. High scores correlated significantly with the duration of surgery (P = 0.007), the need of intensive care unit management (P = 0.001) and the length of stay (P = 0.001). However, there was no significant association between the preoperative score and the rate of conversion (P = 0.103) or the rate of complication (P = 0.209).
  
  
  CONCLUSIONS
  This preoperative clinical scoring system has a potential to select patients with severe cholecystitis and therefore might be a useful tool in clinical decision making.
authors.affiliation: Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany. Electronic address: peter.ambe@helios-kliniken.de.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ambe
authors.affiliation: Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany.
authors.forename: Marios
authors.initials: M
authors.lastname: Papadakis
authors.affiliation: Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Zirngibl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis* / Q000601:surgery; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Acute cholecystitis; Gallbladder wall thickness, elevated CRP; High white blood count; Laparoscopic cholecystectomy; Preoperative clinical score