介绍出现急性结石性胆囊炎(AC)和肝酶标志物(LEM)升高的患者,通常需要评估并发胆总管结石(CDL)。目前,评估指南遵循美国胃肠病学会内镜检查(ASGE)的建议.目标研究的目的是在社区医院患者队列中外部验证ASGE和Chisholm预测因子。方法我们对两年来因AC和LEM升高到阿森松圣约翰医院就诊的患者进行了回顾性研究。灵敏度(SEN),特异性(SP),阳性预测值(PPV)和阴性预测值(NPV)用于检验ASGE和Chisholm算法的外部有效性。结果共审查了132例患者的图表,包括87名患者。Chisholm预测SEN,SP,PPV和NPV为50%,82%,18%,分别为95%和100%,19%,8%,ASGE预测因子模型为100%。在ASGE模块中,SP和PPV可以显著提高到60%和13%,分别,通过改变一些风险类别,包括年龄和LEM范围。结论在我们的患者队列中对Chisholm模块的外部验证表明,它将导致不必要的成像的低转诊率,因此可能更具成本效益。特别是与目前的ASGE建议相比,这将有更高的转诊率。另一方面,目前ASGE建议连续标记所有患者的CDL,而Chisholm模块漏掉了大约50%。我们还观察到,使用当前的ASGE模块,通过调整一些预测因素,包括年龄和异常肝转氨酶范围,可以提高进一步成像和诊断测试的转诊率。但这一观察结果是任意的,需要在更大的队列研究中进行验证.
Introduction Patients that are presented with acute calculus cholecystitis (AC) and elevated liver enzymes markers (LEM), often require evaluation for concurrent choledocholithiasis (CDL). Currently, evaluation guidelines follow the American Society of Gastroenterology Endoscopy (ASGE) recommendations. Objectives The aim of the study was to externally validate both ASGE and the Chisholm predictors in a community hospital patient cohort. Methods We conducted a retrospective study of patients who presented to Ascension Saint John hospital with AC and elevated LEM over a period of two years. Sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were used to test the external validity of ASGE and Chisholm algorithms. Results A total of 132 patients\' charts were reviewed, and 87 patients included. Chisholm predictors SEN, SP, PPV and NPV were 50%, 82%, 18%, and 95% respectively versus 100%, 19%, 8%, 100% for the ASGE predictors model. In the ASGE module, SP and PPV can be significantly improved to 60% and 13%, respectively, by changing a few risk categories including age and LEM range. Conclusions External validation of the Chisholm module in our patient cohort showed that it would lead to a low referral rate for unnecessary imaging and thus might be more cost-effective, especially when compared to current ASGE recommendations which would have a higher referral rate. On the other hand, current ASGE recommendations successively labeled all the patients with CDL, while the Chisholm module missed around 50 percent. We also observed that with the current ASGE module, the referral rate for further imaging and diagnostic tests can be possibly improved by adjusting a few of the predictors including the age and the abnormal liver transaminases range, but this observation is arbitrary and will need to be validated in a larger cohort study.