Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 11 , ISSUE 3 ( September-December, 2022 ) > List of Articles


Classification Schemes for Acute Cholecystitis

Michael W Cripps, Nell T Weber

Keywords : American Association for Surgery of Trauma grade, Cholecystitis, Cholecystitis grading scale, Emergency surgery, Parkland grading scale, Tokyo Guidelines

Citation Information : Cripps MW, Weber NT. Classification Schemes for Acute Cholecystitis. Panam J Trauma Crit Care Emerg Surg 2022; 11 (3):139-144.

DOI: 10.5005/jp-journals-10030-1394

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


The impact of the increasing burden of emergency general surgery (EGS) cannot be understated. Each year, millions of patients will present to the hospital with a condition that will require an emergency operation. Over the past 2 decades, there has been a steady increase in this patient volume. Both calculous and acalculous cholecystitis account for 12% of the entire EGS population, making laparoscopic cholecystectomy one of the most commonly performed operations. With increased scrutiny of operating room utilization and postoperative complications, it has become imperative to be able to qualify disease severity and risk-adjust patients in order to accurately compare outcomes. We recognize that not all cholecystitis is created equal, with the spectrum running from minimal to no inflammation in symptomatic cholelithiasis to perforated gangrenous cholecystitis adhered to the duodenum. Such high variance calls for a reliable cholecystitis scoring system to allow the surgical team to properly educate the patient on their risks for complications, prepare for operative time, and appropriately analyze outcomes. This article will review the three predominant scoring systems for acute cholecystitis—the Tokyo grading scale, the American Association for Surgery of Trauma (AAST) grading scale, and the Parkland grading scale (PGS) for cholecystitis to review their development, strengths, and weaknesses.

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