Signs and Evidence

Making clinical sense of scientific data

SEARCH

Cholecystitis

Calculated pretest-probability: 5 %
Relevant inclusion criteria: Acute abdominal pain Calculate probabilities!

Clinical signs

Murphy's sign
 Positive likelihood ratio
2.80 ( Trowbridge RL et al. )
5.00 ( Abraham S et al. )
1.24 ( Hwang H et al. )
(average) 3.01
Negative likelihood ratio
0.50 ( Trowbridge RL et al. )
0.40 ( Abraham S et al. )
0.71 ( Hwang H et al. )
(average) 0.54
Chills
 Positive likelihood ratio
2.60 ( Abraham S et al. )
(average) 2.60
Negative likelihood ratio
0.90 ( Abraham S et al. )
(average) 0.9
Rebound tenderness
 Positive likelihood ratio
1.90 ( Trowbridge RL et al. )
1.70 ( Abraham S et al. )
(average) 1.80
Negative likelihood ratio
0.75 ( Trowbridge RL et al. )
0.43 ( Abraham S et al. )
(average) 0.59
Right upper quadrant pain
 Positive likelihood ratio
1.50 ( Trowbridge RL et al. )
2.50 ( Abraham S et al. )
(average) 2.00
Negative likelihood ratio
0.70 ( Trowbridge RL et al. )
0.28 ( Abraham S et al. )
(average) 0.49
Vomiting
 Positive likelihood ratio
1.50 ( Trowbridge RL et al. )
(average) 1.50
Negative likelihood ratio
0.60 ( Trowbridge RL et al. )
(average) 0.6
Fever
 Positive likelihood ratio
1.50 ( Trowbridge RL et al. )
(average) 1.50
Negative likelihood ratio
0.90 ( Trowbridge RL et al. )
(average) 0.9
Anorexia
 Positive likelihood ratio
1.40 ( Trowbridge RL et al. )
(average) 1.40
Negative likelihood ratio
0.70 ( Trowbridge RL et al. )
(average) 0.7
Nausea
 Positive likelihood ratio
1.10 ( Trowbridge RL et al. )
(average) 1.10
Negative likelihood ratio
0.80 ( Trowbridge RL et al. )
(average) 0.8

Further signs

CT for cholecystitis
 Positive likelihood ratio
6.00 ( Klugsberger B et al. )
(average) 6.00
Negative likelihood ratio
0.12 ( Klugsberger B et al. )
(average) 0.12
MRI for cholecystitis
 Positive likelihood ratio
4.78 ( Kiewiet JJS et al. )
(average) 4.78
Negative likelihood ratio
0.17 ( Kiewiet JJS et al. )
(average) 0.17
Ultrasound for cholecystitis
 Positive likelihood ratio
4.32 ( Kiewiet JJS et al. )
13.80 ( Klugsberger B et al. )
2.84 ( Kumar K et al. )
4.40 ( Shea JA et al. )
(average) 6.34
Negative likelihood ratio
0.22 ( Kiewiet JJS et al. )
0.33 ( Klugsberger B et al. )
0.57 ( Kumar K et al. )
0.15 ( Shea JA et al. )
(average) 0.32
Leukocytosis (> 10000 / ml)
 Positive likelihood ratio
1.47 ( Trowbridge RL et al. )
(average) 1.47
Negative likelihood ratio
0.65 ( Trowbridge RL et al. )
(average) 0.65

Sources used:

1.Trowbridge RL et al. Does This Patient Have Acute Cholecystitis? JAMA, January 1, 2003—Vol 289, No. 1 80-86
2.Abraham S et al. Surgical and Nonsurgical Management of Gallstones. Am Fam Physician. 2014 May 15;89(10):795-802
3.Hwang H et al. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014 Jun; 57(3): 162–168
4.Kiewiet JJS et al. A Systematic Review and Meta-Analysis of Diagnostic Performance of Imaging in Acute Cholecystitis. Radiology September 2012 Volume 264, Issue 3
5.Klugsberger B et al. Clinical Value of Sonography and CT-Scan in the Diagnosis of Acute Cholecystitis: A Retrospective Analysis. Ann Emerg Surg 2(3): 1021 (2017)
6.Kumar K et al. To study the sensitivity and specificity of Ultrasonography for diagnosing cholelithiasis in a tertiary care teaching hospital Int J Med Res Prof.2015;1(3); 64-67
7.Shea JA et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med. 1994;154(22):2573–2581