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

Acute cholangitis (AC) is associated with a high mortality even among treated patients. Therefore, early diagnosis and treatment are important for improving prognosis. We investigated the discriminatory ability of the Tokyo Guidelines 2018 (TG18) regarding the presence of inflammation (A criterion) and affected liver parameters (B criterion) as a guide to diagnose AC among unselected patients in the emergency department (ED).

The study was designed as a cohort study of adult ED patient visits in the Region of Southern Denmark. The cohort included patient visits collected from seven EDs between 1 January 2016 and 20 March 2018. We examined the diagnostic accuracy of the TG18 A and B criteria. This project was approved by the Danish Patient Safety Authority (identifier 3-3013-2272/1). The Region of Southern Denmark authorised data storage (identifier 17/24904, amendment identifier 20/24502).

We included 202,881 ED patient visits, of which 19,816 met the TG18 A and B criteria. A total of 517 patient visits had a discharge diagnosis compatible with AC. The TG18 had a sensitivity of 85.1% (95% CI: 81.7-88.1%) and a specificity of 90.4% (95% CI: 90.3-90.6%).

The TG18 A and B criteria demonstrated high diagnostic accuracy for predicting AC, even among unselected adult patients in the ED, and were effective at identifying patients who required radiological imaging to confirm or rule out suspected AC.

None.

Not relevant.