Emergency Department Evaluation of Geriatric Patients with Acute Cholecystitis
Version of Record online: 29 SEP 2008
© 1997 Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 4, Issue 1, pages 51–55, January 1997
How to Cite
Parker, L. J., Vukov, L. F. and Wollan, P. C. (1997), Emergency Department Evaluation of Geriatric Patients with Acute Cholecystitis. Academic Emergency Medicine, 4: 51–55. doi: 10.1111/j.1553-2712.1997.tb03643.x
- Issue online: 29 SEP 2008
- Version of Record online: 29 SEP 2008
- Received May 8, 1996 revised July 15, 1996 accepted July 28, 1996
- acute cholecystitis;
- abdominal pain;
- acute abdomen
Objective: To estimate the frequency of abnormal clinical symptoms, laboratory tests, and diagnostic imaging studies in the ED assessment of elderly (≥65 yr) patients with acute cholecystitis, and to compare these factors in the young-old (65–74 yr), middle-old (75–84 yr), and old-old (≥85 yr) population groups.
Methods: A retrospective, cross-sectional study was performed by review of ED records, hospital charts, and surgical operative reports of consecutive elderly ED patients determined at surgery to have acute cholecystitis. Records were reviewed between April 1990 and April 1995 at a large Midwestern tertiary care facility with 65,000 annual ED patient visits. Clinical signs and symptoms were compared in the young-old, middle-old, and old-old population groups.
Results: Of the 168 patients reviewed, 141 (84%) had either epigastric or right upper quadrant abdominal pain, and 8 (5%) had no pain whatsoever. Only 61 patients (36%) had back or flank pain radiation. Ninety-six (57%) experienced nausea, 64 (38%) had emesis, and 13 (8%) had visible jaundice. Ninety-four (56%) patients were afebrile and 69 (41%) had no increase of white blood cell count. Twenty-two (13%) patients had no fever and all tests were normal. No statistical difference was noted in any symptom or laboratory factor for the 3 age groups, except jaundice was more common among the patients aged ≥85 years. Ultra-sonography was diagnostic for 91%, and CT was beneficial for only 1 patient. Eight patients had normal results on their ultrasonographic and CT studies.
Conclusion: Classic symptoms and abnormal blood test results are frequently not present in geriatric patients with acute cholecystitis. Increasing age does not appear to affect the clinical and test markers used by clinicians to diagnose this illness. A high degree of awareness is essential for correct diagnosis of acute cholecystitis in geriatric patients.