Maryam Razavi

maryam.razavi@cambio.se

Cambio CDS

To provide diagnostic criteria and severity grading for acute cholecystitis.

Use in patients with suspected acute cholecystitis (i.e., right upper quadrant tenderness, liver enzyme abnormalities, imaging findings characteristic of acute cholecystitis). Formula: Patient must have a suspected diagnosis (≥1 item in A + ≥1 item in B or C) or definite diagnosis (≥1 item in A, B, and C) to meet entry criteria for severity grading, see table below: Diagnosis: Criteria Part A Local signs of inflammation Murphy's sign Right upper abdominal quadrant mass, pain, or tenderness Part B Systemic signs of inflammation Fever Elevated CRP Elevated WBC count Part C Imaging Imaging findings characteristic of acute cholecystitis* *e.g. pericholecystic fluid, gallstones/debris. Severity grading: Grade III (dysfunction in ≥1 of the following): Cardiovascular dysfunction: hypotension requiring treatment with dopamine ≥5 μg/kg per min or any dose of norepinephrine Neurological dysfunction: decreased level of consciousness Respiratory dysfunction: PaO2/FiO2 ratio <300 Renal dysfunction: oliguria or creatinine >2.0 mg/dL Hepatic dysfunction: PT‐INR >1.5 Hematological dysfunction: platelet count <100,000/mm3 Grade II (≥1 of the following conditions): Elevated WBC count (>18,000/mm3) Palpable tender mass in the right upper abdominal quadrant Duration of complaints >72 hours Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis) Grade I Acute cholecystitis does not meet the above criteria; no organ dysfunction and mild inflammatory changes in the gallbladder Interpretation: Grade Acute cholecystitis severity 30day mortality I Mild 1.1% II Moderate 0.8% III Severe 5.4%

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OBSERVATION.tg18_cholecystitis.v0, EVALUATION.tg18_cholecystitis_assessment.v0