To determine the predictive value of emergency, bedside ultrasound (EUS) signs in the detection of acute cholecystitis (AC). This was a secondary analysis of a previously reported prospective study of EUS for AC. Cases done by physicians who met the training guidelines of the American College of Emergency Physicians by performing 25 prior examinations were selected to determine the predictive value of specific EUS signs for AC. The gold standard was surgical pathology obtained within 2 weeks, if available. Otherwise, the discharge diagnosis of AC was used as the criterion standard. A total of 291 patients were studied to evaluate the predictive value of EUS signs in the detection of AC. Gallbladder wall thickening (GBWT) and perichole-cystic free fluid (PCFF) were the two most predictive individual signs for AC. The combination of gallstones with GBWT, PCFF, or sludge was also predictive of AC. Biliary ductal dilation and gallstones were the only least predictive signs. The combination of gallstones and GBWT, PCFF, or sludge on emergency ultrasound is predictive of AC.
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