Cholecystitis: Likelihood Ratios

Introduction: Cholecystitis is an acute infection of the gallbladder almost universally because of obstruction by gallstones (Cholelithiasis), though the entity of acalculous cystitis exists (often in the context of hypotension and shock).

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Tags: Gastrointestinal Problem Hepatic Infection Physical Exam Tag this Diagnosis.

The likelihood ratios of findings for Cholecystitis are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Negative Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] RUQ Tenderness	+ 0 -	1.7	0.4
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Negative Findings
Finding	Result	+LR	-LR
[ + ] Rectal tenderness	+ 0 -	0.4	1.1
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Findings With Unspecified Accuracy
Finding	Result	+LR	-LR
[ + ] Ultrasound		No accuracy specified.
Study: no study specified.
[ + ] Epigastric Pain		No accuracy specified.
Study: no study specified.

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] HIDA scan	+ 0 -	9.7	0
HIDA (hydroxyminodiacetic acid) scan in cholecystitis shows the liver by the isotope, but the gallbladder is not seen indicates an obstructed cystic duct. Study: Arch Intern Med 1994 Nov 28;154(22):2573-81. PMID 7979854
[ + ] Abdominal CT	+ 0 -	101.9	0.1
75 patients retrospectively (comparing acute chole, acute gangrenous chole, and no cholecystitis) Study: AJR Am J Roentgenol. 2002 Feb;178(2):275-81. PMID: 11804880
[ + ] Abdominal US	+ 0 -	4.4	0.2
note that accuracy of US for detecting gallstones is sens=84%,spec=99%. Study: Arch Intern Med 1994 Nov 28;154(22):2573-81. PMID 7979854
[ + ] RUQ Pain	+ 0 -	2.5	0.3
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Murphy sign	+ 0 -	5	0.4
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] Abdominal Rigidity	+ 0 -	0.8	1
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Leukocytosis and fever	+ 0 -	1.6	0.9
Leukocytosis is >10k/ul Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] hearing loss	+ 0 -	1.8	0.8
>35 C Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Elevated Total Bilirubin, AST, and Alk Phos	+ 0 -	1.7	0.8
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] RUQ Mass	+ 0 -	1.1	1
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Guarding	+ 0 -	1.5	0.8
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Rebound	+ 0 -	0.9	1
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Elevated Total Bilirubin	+ 0 -	1.2	0.9
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Elevated Serum Transaminases	+ 0 -	1	1
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Leukocytosis	+ 0 -	1.5	0.6
>10k/ul Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Emesis	+ 0 -	1.5	0.5
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Elevated Alkaline Phosphatase	+ 0 -	0.9	1.1
>120U/L Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Anorexia	+ 0 -	1.3	0.7
Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80
[ + ] Elevated Total Bilirubin, AST, or Alk Phos	+ 0 -	1.2	0.7
(any one elevated) Study: JAMA. 2003;289:80-86. http://jama.ama-assn.org/cgi/content/full/289/1/80