Gallbladder - Acute Cholecystitis Risk Assessment Tool

Non-Ultrasound Parameters

Patient Sex:

Female

Male

Use whatever is listed in the EMR

Patient Age:

Less than 30 years old

30-59 years old

60 years or older

No need to consider birthday, just use what is shown in EMR as age of patient

WBC Count:

Elevated (based on EMR highlight and showing arrow up)

Not elevated

Unknown

Most recent WBC during this episode of care; ok if within 1 day

Ultrasound Parameters

Scan Pain (with or without pain meds):

Unable to assess (pt not responsive--this is almost never the case for outpatients)

Minimal or no pain

Mild or more pain, but not max at GB (max is elsewhere, like epigastric or flank)

Mild or more pain, unsure max at GB (pain at GB but also at other places)

Mild or more pain, probably max at GB

Mild or more pain, definitely max at GB

If sonographer's note is unclear or not present, mark as unsure

GB Distention (measured from mid-wall to mid-wall, on sagittal image):

≥ 41 mm

36 to 40 mm

31 to 35 mm

< 31 mm

GB Wall:

Definitely normal

Thought to be normal allowing for degree of distention

Chronic thick (previous imaging > 3 days ago shows wall thickening; or wall is thick but patient has known/strongly suspected systemic process like hepatitis/pancreatitis)

Possibly thick (subjective, but "about 2.5-3.5 mm" if > 35 mm diameter); or wall is thick but patient has possible (not strongly suspected) systemic process

Definitely thick (subjective, but "about > 3.5 mm" if > 35 mm diameter); not a chronic observation

GB Contents:

No sludge or stones

Possible minor sludge vs artifact

Definite sludge but typical in appearance (if the patient also has stones, don't choose this descriptor)

Unusual sludge, but clearly no demonstrable stones

Equivocal stones (possible, not definite)--use when not sure if observing stones vs polyps or sludge balls

Stones, typical

Worrisome contents: stones which appear impacted at cystic duct, stones with more than minor amount of sludge, or atypical sludge with equivocal or definite stones

Pericholecystic Irregular Collection:

Not present

Probably present

Definitely present

This refers to a discrete measurable collection of fluid, that is not round/regular. It does NOT refer to diffuse wall edema, striations, ascites, or a sliver of fluid adjacent to the GB.

Hepatic Artery Peak Systolic Velocity (PSV):

< 70 cm/sec

70 to 99 cm/sec

100 to 130 cm/sec

> 130 cm/sec

Unknown

If more than one measurement taken, use whatever waveform seems best

Is there another reasonable cause for patient's symptoms/presentation identified by imaging (either this study or preceding CT or MR during this episode of care)?

Yes

Unsure

Consider findings from current study and any preceding CT or MR imaging during this episode of care

Is there another imaging observation (either in this study or preceding CT or MR during this episode of care) substantially increasing the concern for acute cholecystitis which has not been incorporated in the assessment?

Yes

Unsure

Consider any findings that increase cholecystitis concern but aren't already captured in the assessment parameters

Gallbladder - Acute Cholecystitis Risk Assessment Tool

Non-Ultrasound Parameters

Ultrasound Parameters

Assessment Results

Risk of Acute Cholecystitis:

Findings for Report:

Impression for Report: