tokyo_guidelines_cholecystitis_2018: Tokyo Guidelines 2018 (TG18) for Acute Cholecystitis

In cliot: Clinical Indices and Outcomes Tools

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)

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).

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.

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)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.