Abstrait

Evaluating Diagnostic Markers to Predict Acute Cholecystitis

Wei Wei

Acute Cholecystitis (AC) affects an estimated 20 million patients annually in the United States. The standard of care for treatment is latively straight forward, often times ambulatory Laparoscopic Cholecystectomy (LC). However, in critically ill patients the risk of general anesthesia and a surgical cholecystectomy is often prohibitive. Instead, placement of Percutaneous Cholecystostomy (PC) is preferable. Percutaneous Cholecystostomies can serve as either a definitive procedure or bridging therapy until the patient is clinically stable for a surgical cholecystectomy. During the course of an ICU stay, patients can develop classic signs and symptoms that are attributed to acute cholecystitis standard clinical, laboratory and radiological markers used to diagnose acute cholecystitis are by default and perhaps incorrectly, used to justify PC placement in this unique patient population. The purpose of our study was to establish evidence-based criteria for placement of PC in critically ill patients with a nonbiliary diagnosis on admission. Our goal was to evaluate diagnostic markers for acute cholecystitis and the need for a PC in ICU patients, as opposed to defining criteria for PC placement in patients who were critically ill from their gallbladder disease. Our hypothesis was that the “classic” markers of acute cholecystitis including right upper quadrant pain, elevated WBC and ultrasound findings of gallbladder wall thickening have low-diagnostic yield in the intensive care unit patient population. We further postulated that relying on classic markers results in an over-diagnosis of acute cholecystitis and unnecessary PC placement. By establishing evidence-based criteria for placement of percutaneous cholecystostomy tubes we hope to prevent unnecessary testing and procedures