Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 11-12, Pages: 681-687
https://doi.org/10.2298/SARH1512681P
Full text ( 3094 KB)
Cited by
Scoring system development and validation for prediction choledocholithiasis before open cholecystectomy
Pejović Tomislav (General Hospital, Department of Surgery, Gornji Milanovac)
Stojadinović Miroslav M. (Clinical Centre of Kragujevac, Clinic of Urology and Nephrology, Department of Urology, Kragujevac)
Introduction. Accurate precholecystectomy detection of concurrent
asymptomatic common bile duct stones (CBDS) is key in the clinical
decision-making process. The standard preoperative methods used to diagnose
these patients are often not accurate enough. Objective. The aim of the study
was to develop a scoring model that would predict CBDS before open
cholecystectomy. Methods. We retrospectively collected preoperative
(demographic, biochemical, ultrasonographic) and intraoperative
(intraoperative cholangiography) data for 313 patients at the department of
General Surgery at Gornji Milanovac from 2004 to 2007. The patients were
divided into a derivation (213) and a validation set (100). Univariate and
multivariate regression analysis was used to determine independent predictors
of CBDS. These predictors were used to develop scoring model. Various
measures for the assessment of risk prediction models were determined, such
as predictive ability, accuracy, the area under the receiver operating
characteristic curve (AUC), calibration and clinical utility using decision
curve analysis. Results. In a univariate analysis, seven risk factors
displayed significant correlation with CBDS. Total bilirubin, alkaline
phosphatase and bile duct dilation were identified as independent predictors
of choledocholithiasis. The resultant total possible score in the derivation
set ranged from 7.6 to 27.9. Scoring model shows good discriminatory ability
in the derivation and validation set (AUC 94.3 and 89.9%, respectively),
excellent accuracy (95.5%), satisfactory calibration in the derivation set,
similar Brier scores and clinical utility in decision curve analysis.
Conclusion. Developed scoring model might successfully estimate the presence
of choledocholithiasis in patients planned for elective open cholecystectomy.
Keywords: scoring system, choledocholithiasis, open cholecystectomy
Projekat Ministarstva nauke Republike Srbije, br. 175014