Tokyo Guidelines' performance in predicting acute cholangitis among emergency department patients

Area of Science:

• Hepatology
• Gastroenterology
• Emergency Medicine

Background:

• Acute cholangitis (AC) presents a high mortality risk, underscoring the need for prompt diagnosis and treatment.
• Early identification of AC is crucial for improving patient prognosis and outcomes.

Purpose of the Study:

• To evaluate the diagnostic performance of the Tokyo Guidelines 2018 (TG18) for acute cholangitis (AC).
• To assess the discriminatory ability of TG18 inflammation (A criterion) and liver parameter (B criterion) criteria in unselected emergency department (ED) patients.

Main Methods:

• A cohort study analyzed adult ED patient visits in the Region of Southern Denmark from January 2016 to March 2018.
• Diagnostic accuracy of TG18 A and B criteria for AC was examined.
• Study approved by the Danish Patient Safety Authority and Region of Southern Denmark.

Main Results:

• The study included 202,881 ED patient visits; 19,816 met TG18 A and B criteria.
• A total of 517 patient visits had a discharge diagnosis compatible with AC.
• TG18 demonstrated a sensitivity of 85.1% and specificity of 90.4% for AC diagnosis.

Conclusions:

• The TG18 A and B criteria exhibit high diagnostic accuracy for AC in unselected ED patients.
• TG18 effectively identifies patients requiring radiological imaging to confirm or exclude AC.