'Lewisham scoring system' to facilitate the clinical diagnosis of empyema

Patients with empyema of gall bladder have a higher mortality rate. We hypothesised a scoring system, which we call the Lewisham Score, to predict the development and diagnosis of empyema.

Patient with histologically proven acute cholecystitis who underwent operation over a five year period (2004-2009) were selected and a retrospective cohort analysis of those who developed empyema vs. simple acute cholecystitis was performed. Various parameters and the Lewisham score were compared.

Patients with empyema were elderly females with a higher C-reactive protein and had a higher Lewisham Score of > 5 and those with simple cholecystitis had a lower Lewisham score (< 4) and lower C-reactive protein.

Patients with proven acute cholecystitis and a Lewisham score > 5 should undergo cholecystectomy at the same admission.