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

IF 1.1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Danish medical journal Pub Date : 2026-03-19 DOI:10.61409/A09250722

Amalie Kuno Riis, Christina Søndergaard Willumsen, Annmarie Touborg Lassen, Flemming Schønning Rosenvinge, Isik Somunco Johansen, Christian Backer Mogensen, Stig Borbjerg Laursen

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引用次数: 0

Abstract

Introduction: 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).

Methods: 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).

Results: 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%).

Conclusions: 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.

Funding: None.

Trial registration: Not relevant.

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东京指南在预测急诊科患者急性胆管炎中的表现。

急性胆管炎（AC）与高死亡率相关，即使在接受治疗的患者中也是如此。因此，早期诊断和治疗对改善预后至关重要。我们研究了东京指南2018 （TG18）在炎症（A标准）和肝脏参数影响（B标准）方面的区分能力，作为在急诊科（ED）未选择患者中诊断AC的指南。方法：该研究被设计为丹麦南部地区成人急诊科患者就诊的队列研究。该队列包括2016年1月1日至2018年3月20日期间从7个急诊科收集的患者就诊情况。我们检验了tg18a和tg18b标准的诊断准确性。该项目已获得丹麦患者安全局（标识符3-3013-2272/1）的批准。丹麦南部地区授权数据存储（标识符17/24904，修订标识符20/24502）。结果：我们纳入了202,881例ED患者就诊，其中19,816例符合TG18 A和B标准。共有517例患者就诊的出院诊断与AC相符。TG18的敏感性为85.1% (95% CI: 81.7-88.1%)，特异性为90.4% （95% CI: 90.3-90.6%）。结论：TG18 A和B标准在预测AC方面显示出很高的诊断准确性，即使在未选择的急诊科成年患者中也是如此，并且在识别需要放射成像来确认或排除疑似AC的患者方面是有效的。试验注册：不相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Danish medical journal MEDICINE, GENERAL & INTERNAL-

CiteScore

2.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： The Danish Medical Journal (DMJ) is a general medical journal. The journal publish original research in English – conducted in or in relation to the Danish health-care system. When writing for the Danish Medical Journal please remember target audience which is the general reader. This means that the research area should be relevant to many readers and the paper should be presented in a way that most readers will understand the content. DMJ will publish the following articles: • Original articles • Protocol articles from large randomized clinical trials • Systematic reviews and meta-analyses • PhD theses from Danish faculties of health sciences • DMSc theses from Danish faculties of health sciences.