Comparison and compliance of clinical methods for applicants with right upper abdomen pain and patients diagnosed with acute cholecystitis / acute cholangitis according to tokyo guideline 2013 / 2018 (TK13/18) in emergency department

Introduction and Objective: In this study, adult patients who presented with right upper quadrant pain and were diagnosed as acute cholecystitis / acute cholangitis were examined retrospectively according to the Tokyo 2013/2018 Guide (TK13/18). The aim of the study was to determine the value of hospital stay, the need for intensive care and the predictability of mortality. Material-Method: A retrospective chart review of the clinical management of patients according to the Tokyo 2013/2018 guide (TG13/18), who was admitted to the Emergency Department of Dokuz Eylül University Hospital between January 01, 2016 and December 31, 2017 with right upper quadrant pain and diagnosed as acute cholecystitis / acute cholangitis in a two-year period was done with. According to ICD10 Code, patients with K81-83 Codes were selected and obtained from hospital database. Data for each patient were recorded in the data collection form. SPSS 22.0 Windows and Vassarstats were used for statistical analysis. Results: In a two-year period, a total of 439 patients received K81-83 diagnostic codes, of which 266 patients met the study criteria, out of 173 excluded whose 135 patients had other biliary tract diseases, 21 had pancreatic diseases, 11 had bowel diseases, 6 had liver diseases. Of the 266 patients included, 154 (58%) were females and the mean age was 61 years, 11 months ± 19 years and 3 months, and 61 years 1 month ± 15 years and 1 month, respectively. Of 213 (80%) patients had a. cholecystitis, 49 (18.4%) patients had a. cholangitis and 4 (1.4%) patients had both a. cholecystitis and a. cholangitis. If the criteria of TG 13/18 were used, 69 of the 213 patients (32%) with a preliminary diagnosis of cholecystitis would also get a diagnosis of a. cholangitis. Of these 69 patients, 31 (44%) were TG 13/18 a. cholangitis met the exact diagnostic criteria (Pearson chi-square, p = 0.00). The rates of a. cholecystitis and a. cholangitis were not changed but the two patients had suspicious a. cholangitis diagnosis. Conclusion: There was a significant relationship between the preliminary diagnosis of acute cholecystitis and all local inflammation findings. Preliminary diagnosis of acute cholecystitis and acute cholangitis significant correlations were found between systemic inflammation findings and absence of fever and white blood cell count. TG13 / 18 imaging criteria and acute cholecystitis and acute cholangitis were found to be significantly correlated. There was a coherent relationship between the outcome of the patients with acute cholecystitis and the stage scores, but there was no consistent correlation with acute cholecystitis. USG was more effective than CT in patients with a preliminary diagnosis of acute cholangitis. In our study, if TG 13/18 criteria had been used retrospectively, according to our data, the diagnosis and treatment management of the patients diagnosed with acute cholecystitis would have not change significantly. However, we found that 69 additional patients (32%) with acute cholangitis could have been diagnosed by using TG 13/18 criteria and their diagnosis and treatment plans would have been changed significantly. Although the number of studies in the emergency departments related to TG 13/18 is limited, more publications are needed to evaluate the effectiveness of the guideline.