{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:39:37Z","timestamp":1780544377110,"version":"3.54.1"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,3,11]],"date-time":"2017-03-11T00:00:00Z","timestamp":1489190400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,3]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Acute cholecystitis (AC<\/jats:styled-content>) is a common differential for patients presenting to the emergency department (ED<\/jats:styled-content>) with abdominal pain. The diagnostic accuracy of history, physical examination, and bedside laboratory tests for AC<\/jats:styled-content> have not been quantitatively described.<\/jats:p><\/jats:sec>Objectives<\/jats:title>We performed a systematic review to determine the utility of history and physical examination (H&P), laboratory studies, and ultrasonography (US<\/jats:styled-content>) in diagnosing AC<\/jats:styled-content> in the ED<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>We searched medical literature from January 1965 to March 2016 in PubMed, Embase, and SCOPUS<\/jats:styled-content> using a strategy derived from the following formulation of our clinical question: patients\u2014<\/jats:italic>ED<\/jats:styled-content> patients suspected of AC<\/jats:styled-content>; interventions\u2014<\/jats:italic>H&P, laboratory studies, and US<\/jats:styled-content> findings commonly used to diagnose AC<\/jats:styled-content>; comparator\u2014<\/jats:italic>surgical pathology or definitive diagnostic radiologic study confirming AC<\/jats:styled-content>; and outcome\u2014<\/jats:italic>the operating characteristics of the investigations in diagnosing AC<\/jats:styled-content> were calculated. Sensitivity, specificity, and likelihood ratios (LR<\/jats:styled-content>s) were calculated using Meta\u2010DiSc with a random\u2010effects model (95% CI<\/jats:styled-content>). Study quality and risks for bias were assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies.<\/jats:p><\/jats:sec>Results<\/jats:title>Separate PubMed, Embase, and SCOPUS<\/jats:styled-content> searches retrieved studies for H&P (n\u00a0=<\/jats:italic>\u00a0734), laboratory findings (n\u00a0=<\/jats:italic>\u00a074), and US<\/jats:styled-content> (n\u00a0=<\/jats:italic>\u00a0492). Three H&P studies met inclusion\/exclusion criteria with AC<\/jats:styled-content> prevalence of 7%\u201364%. Fever had sensitivity ranging from 31% to 62% and specificity from 37% to 74%; positive LR<\/jats:styled-content> [LR<\/jats:styled-content>+] was 0.71\u20131.24, and negative LR<\/jats:styled-content> [LR<\/jats:styled-content>\u2013] was 0.76\u20131.49. Jaundice sensitivity ranged from 11% to 14%, and specificity from 86% to 99%; LR<\/jats:styled-content>+ was 0.80\u201313.81, and LR<\/jats:styled-content>\u2013 was 0.87\u20131.03. Murphy's sign sensitivity was 62% (range\u00a0= 53%\u201371%), and specificity was 96% (range\u00a0= 95%\u201097%); LR<\/jats:styled-content>+ was 15.64 (range\u00a0= 11.48\u201321.31), and LR<\/jats:styled-content>\u2013 was 0.40 (range\u00a0= 0.32\u20130.50). Right upper quadrant pain had sensitivity ranging from 56% to 93% and specificity of 0% to 96%; LR<\/jats:styled-content>+ ranged from 0.92 to 14.02, and LR<\/jats:styled-content>\u2013 from 0.46 to 7.86. One laboratory study met criteria with a 26% prevalence of AC<\/jats:styled-content>. Elevated bilirubin had a sensitivity of 40% (range\u00a0= 12%\u201374%) and specificity of 93% (range\u00a0= 77%\u201399%); LR<\/jats:styled-content>+ was 5.80 (range\u00a0= 1.25\u201326.99), and LR<\/jats:styled-content>\u2013 was 0.64 (range\u00a0= 0.39\u20131.08). Five US<\/jats:styled-content> studies with a prevalence of AC<\/jats:styled-content> of between 10% and 46%. US<\/jats:styled-content> sensitivity was 86% (range\u00a0= 78%\u201394%) and specificity was 71% (range\u00a0= 66%\u201376%); LR<\/jats:styled-content>+ was 3.23 (range\u00a0= 1.74\u20136.00), and LR<\/jats:styled-content>\u2013 was 0.18 (range\u00a0= 0.10\u20130.33).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Variable disease prevalence, coupled with limited sample sizes, increases the risk of selection bias. Individually, none of these investigations reliably rule out AC<\/jats:styled-content>. Development of a clinical decision rule to include evaluation of H&P, laboratory data, and US<\/jats:styled-content> are more likely to achieve a correct diagnosis of AC<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13132","type":"journal-article","created":{"date-parts":[[2016,11,16]],"date-time":"2016-11-16T18:38:51Z","timestamp":1479321531000},"page":"281-297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis"],"prefix":"10.1111","volume":"24","author":[{"given":"Ashika","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine SUNY\u2010Downstate Medical Center Brooklyn NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ninfa","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of 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