Signs and Evidence

Making clinical sense of scientific data

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Cholelithiasis

Calculated pretest-probability: 8.4 %
Relevant inclusion criteria: Acute abdominal pain Calculate probabilities!

Clinical signs

Colic pain
 Positive likelihood ratio
3.60 ( Abraham S et al. )
(average) 3.60
Negative likelihood ratio
0.84 ( Abraham S et al. )
(average) 0.84
Radiating pain
 Positive likelihood ratio
1.60 ( Abraham S et al. )
(average) 1.60
Negative likelihood ratio
0.62 ( Abraham S et al. )
(average) 0.62
Rebound tenderness
 Positive likelihood ratio
1.30 ( Abraham S et al. )
(average) 1.30
Negative likelihood ratio
0.73 ( Abraham S et al. )
(average) 0.73
Right upper quadrant pain
 Positive likelihood ratio
1.20 ( Abraham S et al. )
(average) 1.20
Negative likelihood ratio
0.74 ( Abraham S et al. )
(average) 0.74
Nausea
 Positive likelihood ratio
1.20 ( Abraham S et al. )
(average) 1.20
Negative likelihood ratio
0.74 ( Abraham S et al. )
(average) 0.74

Further signs

Ultrasound for cholelithiasis
 Positive likelihood ratio
19.40 ( Shea JA et al. )
7.42 ( Kola S et al. )
(average) 13.41
Negative likelihood ratio
0.03 ( Shea JA et al. )
0.12 ( Kola S et al. )
(average) 0.08

Sources used:

1.Abraham S et al. Surgical and Nonsurgical Management of Gallstones. Am Fam Physician. 2014 May 15;89(10):795-802
2.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
3.Kola S et al. Role of Ultrasonography in the diagnosis of the gallstones. Radiology 2013;4(10)
4.Caporale N et al. Acute abdominal pain in the emergency department of a university hospital in Italy. United European Gastroenterology Journal 2016, Vol. 4(2) 297–304