Diagnostic accuracy of Charcot's triad: a systematic review

ANZ Journal of Surgery - Tập 87 Số 4 - Trang 232-238 - 2017
Steva Rumsey1, Joel Winders1, Andrew D. MacCormick2,1
1Department of Surgery, University of Auckland, Auckland, New Zealand
2Department of Surgery, Middlemore Hospital, Auckland, New Zealand

Tóm tắt

BackgroundCharcot's triad is a well‐established diagnostic tool for acute cholangitis (AC). It has been recognized as an inaccurate test in clinical practice; however, its exact sensitivity and specificity remain unclear. This knowledge is key to informing the value of its continued clinical application. The objectives of this study are to calculate an estimate of the sensitivity and specificity of Charcot's triad based on published research and consider its applicability to clinical practice and medical education.MethodsElectronic database search for relevant literature and review of reference lists of the subsequent articles for additional resources. Two independent researchers located articles which were qualitatively and quantitatively reviewed. The overall sensitivity and specificity values across all studies were subsequently calculated.ResultsThe 16 articles included in the review varied widely in study design and the sensitivity of Charcot's triad was reported for AC. Across the included articles, there were 4288 patients studied. The overall sensitivity for Charcot's triad was calculated as 36.3%. The specificity was only analysed in three studies and had an overall value of 93.2%. Nine of the articles also investigated the sensitivity of Reynold's pentad which was consistently low with an overall value of 4.82%. The specificity of Reynold's pentad was not studied.ConclusionCharcot's triad has limited clinical utility as a diagnostic algorithm for AC. It is an effective rule‐in test but a poor rule‐out test and should be applied and taught accordingly. A more sensitive diagnostic tool is required to achieve superior outcomes for AC patients.

Từ khóa


Tài liệu tham khảo

10.1038/nrgastro.2009.126

10.1097/00000658-198003000-00002

10.1097/00000658-196902000-00015

10.1097/00000658-195908000-00013

10.1007/s00534-012-0537-3

10.1007/s00534-006-1156-7

10.1007/s00534-006-1152-y

10.1016/S0140-6736(89)92696-2

10.1056/NEJM199206113262401

10.1007/s00534-006-1153-x

10.3748/wjg.v8.i1.150

10.1136/gut.2007.121657

10.1007/s00534-012-0561-3

10.1007/s00534-011-0464-8

10.1016/S1499-3872(13)60062-4

10.1007/s00534-012-0538-2

10.1007/s00534-010-0338-5

10.7326/0003-4819-151-4-200908180-00135

10.1002/jhbp.9

10.1002/bjs.1800790720

Doganay M, 2010, Clinical determinants of suppurative cholangitis in malignant biliary tract obstruction, Bratisl. Lek. Listy, 111, 336

10.1001/archsurg.1967.01330100024004

10.1007/s10620-005-3035-5

Tomizawa M, 2012, Acute cholangitis in elderly patients exploring diagnostic clues and clinical signs, J. Gastroenterol. Hepatol. Res., 1, 223

10.1111/j.1443-1661.1990.tb00062.x

10.1097/00000658-198904000-00008

10.1097/00000658-199001000-00009

Rosing D, 2007, Cholangitis: analysis of admission prognostic indicators and outcomes, Am. J. Surg., 73, 949, 10.1177/000313480707301003

10.1016/0002-9610(76)90003-9

10.1001/archsurg.1982.01380280031007

10.1007/s00534-006-1150-0

Thông tin
Thông tin xuất bản

ANZ Journal of Surgery

Tập 87 Số 4

232-238

Thông tin tác giả