A novel preoperative score to predict severe acute cholecystitis

Authors

Kali Kuhlenschmidt, From the Department of Surgery (K.K.), University of Louisville, Louisville, Kentucky; Department of Surgery (L.R.T.), Medical City Healthcare, Plano, Texas; Department of Surgery (K.M.S.), Yale School of Medicine, New Haven, Connecticut; Department of Surgery (H.M.K., M.E.H.), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery (R.P., M.C.), University of Florida Health Jacksonville, Jacksonville, Florida; Department of Surgery (T.J.S.), University of Colorado Health, Colorado Springs; and Department of Surgery (M.W.C.), University of Colorado Anschutz Medical Center, Aurora, Colorado.Follow
Luis R. TaverasFollow
Kevin M. SchusterFollow
Haytham M. KaafaraniFollow
Majed El Hechi
Ruchir PuriFollow
Marie CrandallFollow
Thomas J. SchroeppelFollow
Michael W. CrippsFollow

Document Type

Article

Publication Title

The journal of trauma and acute care surgery

Abstract

BACKGROUND: In a large multicenter trial, The Parkland Grading Scale (PGS) for acute cholecystitis outperformed other grading scales and has a positive correlation with complications but is limited in its inability to preoperatively predict high-grade cholecystitis. We sought to identify preoperative variables predictive of high-grade cholecystitis (PGS 4 or 5). METHODS: In a six-month period, patients undergoing cholecystectomy at a single institution with prospectively graded PGS were analyzed. Stepwise logistic regression models were constructed to predict high-grade cholecystitis. The relative weight of the variables was used to derive a novel score, the Severe Acute Cholecystitis Score (SACS). This score was compared with the Emergency Surgery Acuity Score(ESS), American Association for the Surgery of Trauma (AAST) preoperative score and Tokyo Guidelines (TG) for their ability to predict high-grade cholecystitis. Severe Acute Cholecystitis Score was then validated using the database from the AAST multicenter validation of the grading scale for acute cholecystitis. RESULTS: Of the 575 patients that underwent cholecystectomy, 172 (29.9%) were classified as high-grade. The stepwise logistic regression modeling identified seven independent predictors of high-grade cholecystitis. From these variables, the SACS was derived. Scores ranged from 0 to 9 points with a C statistic of 0.76, outperforming the ESS ( C statistic of 0.60), AAST (0.53), and TG (0.70) ( p < 0.001). Using a cutoff of 4 or more on the SACS correctly identifies 76.2% of cases with a specificity of 91.3% and a sensitivity of 40.7%. In the multicenter database, there were 464 patients with a prospectively collected PGS. The C statistic for SACS was 0.74. Using the same cutoff of 4, SACS correctly identifies 71.6% of cases with a specificity of 83.8% and a sensitivity of 52.2%. CONCLUSION: The Severe Acute Cholecystitis Score can preoperatively predict high-grade cholecystitis and may be useful for counseling patients and assisting in surgical decision making. LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level III.

First Page

870

Last Page

875

DOI

10.1097/TA.0000000000004308

Publication Date

6-1-2024

Recommended Citation

Kuhlenschmidt, Kali; Taveras, Luis R.; Schuster, Kevin M.; Kaafarani, Haytham M.; El Hechi, Majed; Puri, Ruchir; Crandall, Marie; Schroeppel, Thomas J.; and Cripps, Michael W., "A novel preoperative score to predict severe acute cholecystitis" (2024). Surgery. 19.
https://scholar.bridgeporthospital.org/surgery/19

Identifier

38523119 (pubmed); 10.1097/TA.0000000000004308 (doi); 01586154-990000000-00676 (pii)