{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T03:22:50Z","timestamp":1777951370027,"version":"3.51.4"},"reference-count":20,"publisher":"Danish Medical Association","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dan Med J"],"abstract":"<jats:p>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).\n\nMETHODS. 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).\n\nRESULTS. 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%).\n\nCONCLUSIONS. 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.\n\nFUNDING. None.\n\nTRIAL REGISTRATION. Not relevant.<\/jats:p>","DOI":"10.61409\/a09250722","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T12:11:01Z","timestamp":1774959061000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["Tokyo Guidelines\u2019 performance in predicting acute cholangitis among emergency department patients"],"prefix":"10.61409","author":[{"given":"Amalie Kuno","family":"Riis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina S\u00f8ndergaard","family":"Willumsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annmarie Touborg","family":"Lassen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flemming Sch\u00f8nning","family":"Rosenvinge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isik Somunco","family":"Johansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian Backer","family":"Mogensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stig Borbjerg","family":"Laursen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"40208","published-online":{"date-parts":[[2026,3]]},"reference":[{"key":"ref0","unstructured":"Tan M, Schaffalitzky de Muckadell OB, Laursen SB. Timing af endoskopisk retrograd kolangiopankreatografi ved akut kolangitis. Ugeskr L\u00e6ger. 2018;180:V10170806"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Arvig MD, Mogensen CB, Skj\u00f8t-Arkil H, et al. Chief complaints, underlying diagnoses, and mortality in adult, non-trauma emergency department visits: a population-based, multicenter cohort study. West J Emerg Med. 2022;23(6):855-863. https:\/\/doi.org\/10.5811\/westjem.2022.9.56332","DOI":"10.5811\/westjem.2022.9.56332"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Hou LA, Laine L, Motamedi N, et al. Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis. J Clin Gastroenterol. 2017;51(6):534-538. https:\/\/doi.org\/10.1097\/MCG.0000000000000763","DOI":"10.1097\/MCG.0000000000000763"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Navaneethan U, Gutierrez NG, Jegadeesan R, et al. Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis. Gastrointest Endosc. 2013;78(1):81-90 https:\/\/doi.org\/10.1016\/j.gie.2013.02.003","DOI":"10.1016\/j.gie.2013.02.003"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Gravito-Soares E, Gravito-Soares M, Gomes D, et al. Clinical applicability of Tokyo Guidelines 2018\/2013 in diagnosis and severity evaluation of acute cholangitis and determination of a new severity model. Scand J Gastroenterol. 2018;53(3):329-334. https:\/\/doi.org\/10.1080\/00365521.2018.1430255","DOI":"10.1080\/00365521.2018.1430255"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ely R, Long B, Koyfman A. The emergency medicine-focused review of cholangitis. J Emerg Med. 2018;54(1):64-72. https:\/\/doi.org\/10.1016\/j.jemermed.2017.06.039","DOI":"10.1016\/j.jemermed.2017.06.039"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Kiriyama S, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19(5):548-556. https:\/\/doi.org\/10.1007\/s00534-012-0537-3","DOI":"10.1007\/s00534-012-0537-3"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Mohan R, Goh SWL, Tan GW, et al. Validation of Tokyo Guidelines 2007 and Tokyo Guidelines 2013\/2018 criteria for acute cholangitis and predictors of in-hospital mortality. Visc Med. 2021;37(5):434-442. https:\/\/doi.org\/10.1159\/000516424","DOI":"10.1159\/000516424"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Mohan R, Goh SWL, Tan GW, et al. Validation of TG07 and TG13\/TG18 criteria for acute cholangitis and predictors of in-hospital mortality in patients over 80 years old. Clin Exp Hepatol. 2021;7(4):396-405. https:\/\/doi.org\/10.5114\/ceh.2021.110996","DOI":"10.5114\/ceh.2021.110996"},{"key":"ref9","unstructured":"Danmarks Statistik. FOLK1A: Befolkningen den 1. i kvartalet efter omr\u00e5de, k\u00f8n, alder og civilstand. www.statistikbanken.dk\/FOLK1A"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6(11):e012799. https:\/\/doi.org\/10.1136\/bmjopen-2016-012799","DOI":"10.1136\/bmjopen-2016-012799"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Schmidt M, Pedersen L, S\u00f8rensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014;29(8):541-549. https:\/\/doi.org\/10.1007\/s10654-014-9930-3","DOI":"10.1007\/s10654-014-9930-3"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011;39(7 suppl):30-33. https:\/\/doi.org\/10.1177\/1403494811401482","DOI":"10.1177\/1403494811401482"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383. https:\/\/doi.org\/10.1016\/0021-9681(87)90171-8","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"ref14","unstructured":"European Union. Regulation (EU) 2016\/679 of the European Parliament and of the Council of April 27, 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data. European Union, 2016. https:\/\/eur-lex.europa.eu\/eli\/reg\/2016\/679\/oj"},{"key":"ref15","unstructured":"UN. Act No. 593 relative to ethical medical research. UN, 2011. https:\/\/leap.unep.org\/countries\/dk\/national-legislation\/act-no-593-relative-ethical-medical-research"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Kiriyama S, Takada T, Strasberg SM, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):24-34. https:\/\/doi.org\/10.1007\/s00534-012-0561-3","DOI":"10.1007\/s00534-012-0561-3"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Dinc T, Kayilioglu SI, Coskun F. Evaluation and comparison of Charcot's triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis. Indian J Surg. 2017;79(5):427-430. https:\/\/doi.org\/10.1007\/s12262-016-1512-z","DOI":"10.1007\/s12262-016-1512-z"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Sun G, Han L, Yang Y, et al. Comparison of two editions of Tokyo Guidelines for the management of acute cholangitis. J Hepatobiliary Pancreat Sci. 2014;21(2):113-119. https:\/\/doi.org\/10.1002\/jhbp.9","DOI":"10.1002\/jhbp.9"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Yokoe M, Takada T, Mayumi T, et al. Accuracy of the Tokyo Guidelines for the diagnosis of acute cholangitis and cholecystitis taking into consideration the clinical practice pattern in Japan. J Hepatobiliary Pancreat Sci. 2011;18(2):250-257. https:\/\/doi.org\/10.1007\/s00534-010-0338-5","DOI":"10.1007\/s00534-010-0338-5"}],"container-title":["Danish Medical Journal"],"original-title":[],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:46:05Z","timestamp":1777887965000},"score":1,"resource":{"primary":{"URL":"https:\/\/ugeskriftet.dk\/dmj\/A09250722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":20,"URL":"https:\/\/doi.org\/10.61409\/a09250722","relation":{},"ISSN":["2245-1919"],"issn-type":[{"value":"2245-1919","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}