cliot (version 1.0.0)

tokyo_guidelines_cholecystitis_2018: Tokyo Guidelines 2018 (TG18) for Acute Cholecystitis

Description

Diagnoses and grades the severity of acute cholecystitis based on the 2018 Tokyo Guidelines. The assessment involves three diagnostic criteria categories (Local signs, Systemic signs, Imaging) and specific severity grading criteria based on organ dysfunction and local inflammation.

Usage

tokyo_guidelines_cholecystitis_2018(murphys_sign, ruq_tenderness, temperature_c,
                                    wbc_count, crp_elevated, imaging_positive,
                                    hypotension_meds, altered_consciousness,
                                    pao2_fio2_ratio, creatinine_mg_dl, inr,
                                    platelet_count, palpable_mass, duration_gt_72h,
                                    marked_local_inflammation)

Value

A list containing:

Diagnosis

Diagnostic status (No, Suspected, or Definite Acute Cholecystitis).

Severity_Grade

Severity Classification (Grade I, II, or III) if diagnosed.

Criteria_Met

List indicating which diagnostic criteria categories (A, B, C) were fulfilled.

Arguments

murphys_sign

Numeric (0 or 1). Positive Murphy's sign. (1 = Yes).

ruq_tenderness

Numeric (0 or 1). Right upper quadrant tenderness or pain. (1 = Yes).

temperature_c

Numeric. Body temperature in Celsius. (> 38.0 contributes to diagnosis).

wbc_count

Numeric. White Blood Cell count (x10^3/uL). (> 10 contributes to diagnosis; > 18 contributes to Grade II).

crp_elevated

Numeric (0 or 1). Elevated C-Reactive Protein (>= 3 mg/dL). (1 = Yes).

imaging_positive

Numeric (0 or 1). Imaging findings characteristic of acute cholecystitis. (1 = Yes).

hypotension_meds

Numeric (0 or 1). Hypotension requiring dopamine >= 5 mcg/kg/min or any dose of norepinephrine/dobutamine. (1 = Yes, Grade III).

altered_consciousness

Numeric (0 or 1). Disturbance of consciousness. (1 = Yes, Grade III).

pao2_fio2_ratio

Numeric. PaO2/FiO2 ratio. (< 300 contributes to Grade III). Use NA if not available.

creatinine_mg_dl

Numeric. Serum Creatinine. (> 2.0 mg/dL contributes to Grade III).

inr

Numeric. International Normalized Ratio. (> 1.5 contributes to Grade III).

platelet_count

Numeric. Platelet count (x10^3/uL). (< 100 contributes to Grade III).

palpable_mass

Numeric (0 or 1). Palpable tender mass in the right upper quadrant. (1 = Yes, Grade II).

duration_gt_72h

Numeric (0 or 1). Duration of complaints > 72 hours. (1 = Yes, Grade II).

marked_local_inflammation

Numeric (0 or 1). Marked local inflammation (e.g., gangrenous/emphysematous cholecystitis, abscess, biliary peritonitis). (1 = Yes, Grade II).

References

Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54. doi:10.1002/jhbp.515

Examples

# Example 1: Definite Acute Cholecystitis, Grade II
# Murphy (+), Fever 38.5, WBC 19, Imaging (+), No organ failure, Duration < 72h
tokyo_guidelines_cholecystitis_2018(1, 1, 38.5, 19, 1, 1, 0, 0, 400, 1.0, 1.0, 200, 0, 0, 0)

# Example 2: Suspected Acute Cholecystitis, Grade I
# RUQ pain (+), Fever 38.2, WBC 11, Imaging (-), No severity features
tokyo_guidelines_cholecystitis_2018(0, 1, 38.2, 11, 0, 0, 0, 0, NA, 0.8, 1.0, 250, 0, 0, 0)