Predicting Acute Cholecystitis on Final Pathology to Prioritize Surgical Urgency: An Evaluation of the Tokyo Criteria and Development of a Novel Predictive Score

The Tokyo Guidelines were highly sensitive but nonspecific for the presence of acute inflammation on final pathology. An existing institutional case prioritization rule demonstrated moderate discrimination but was outperformed by a new rule incorporating clinical exam, fever, degree of leukocytosis, and inflammatory changes on imaging. These findings may aid AC prioritization in busy centers, though external validation is needed.