Faikhongngoen Saowaluck, Chenthanakij Boriboon, Wittayachamnankul Borwon, Phinyo Phichayut, Wongtanasarasin Wachira
Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Diagnostics (Basel). 2022 Sep 17;12(9):2246. doi: 10.3390/diagnostics12092246.
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.
我们旨在开发一种用于急性胆囊炎的诊断评分系统，该系统整合症状、体格检查和实验室数据，以帮助临床医生及时发现并早期治疗这种疾病。我们回顾性地从2010年至2020年的数据库中收集数据。纳入在急诊科接受超声或计算机断层扫描（CT）的急性腹痛患者。病例通过病理、CT或超声报告进行确诊。非病例为不符合任何这些标准的患者。进行多变量回归分析以确定急性胆囊炎的预测因素。该模型纳入了244例疑似急性胆囊炎的患者。86例患者（35.2%）为急性胆囊炎确诊病例。简化逻辑模型中保留了五个最终预测因素：年龄<60岁、恶心和/或呕吐、右上腹疼痛、墨菲氏征阳性以及谷草转氨酶（AST）≥正常上限的两倍。实用评分的诊断性能为曲线下面积（AuROC）0.74（95%置信区间，0.67−0.81）。得分9 - 12分的患者被归类为急性胆囊炎高概率患者，阳性似然比为3.79（95%置信区间，1.68−8.94）。基于这五个预测因素的急诊科胆囊炎评分（ED Chole Score）可能有助于在急诊科诊断急性胆囊炎。ED Chole Score>8的患者应进一步检查。
