Development of a scoring system with laboratory and ultrasound parameters to predict the choledocholithiasis

Abstract

Importance: ERCP is an effective method for this pathology but requires that reliable preoperative markers for the presence of choledocholithiasis are established to reduce the number of unnecessary endoscopic procedures. Objective: Develop a system of scoring with ultrasound and laboratory parameters to predict choledocholithiasis. Design, setting, and participants: It is an analytical, prospective, and quantitative study tested diagnostic (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio). The universe is represented by a total of 600 patients that were treated in the surgery service of the Hospital with Hepatobiliopancreatic pathology, the sample is represented by 400 patients of the universe, from January 2012 to July 2016. Exposures: It was conducted using a pre-established protocol review of medical records of Viedma Clinical Hospital. Main Outcome and Measures Determine if using simple a lab test along with the abdominal ultrasound, you can predict the existence of choledocholithiasis and decide to perform therapeutic ERCP. Results: By subjecting all patients studied to the scoring scale, we can see that those with one higher score (add of) >4 have a 31% chance to find stones in the bile duct, and which those which have a score <4 have a 5% chance to find stones in his bile duct, therefore the use of this scoring scale allows us to predict 6 times the probability of present gallstones in the bile duct that if we don't use the same. Conclusion and relevance: The use of diagnostic tests (sensitivity, specificity, predictive value, and likelihood ratio) are effective tests for their discriminatory power between sick and healthy patients. Patients with 4 or more criteria achieve a sensitivity of 66% and a specificity of 90% to predict choledocholithiasis.