Diagnostic accuracy of Charcot's triad: a systematic review

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Acute cholangitis (AC) is a potentially serious cause of abdominal pain in the hospital setting which requires a high index of suspicion.1 Historically, the condition has been diagnosed clinically using Charcot's triad, the combination of right upper quadrant (RUQ) pain, fever and jaundice.2 Reynold's pentad – which includes the addition of shock and lethargy or mental confusion – has also been used as a diagnostic tool to help identify acute obstructive cholangitis.4 Over time, it has been acknowledged that presentations of AC do not consistently fulfil the features of the triad;1 however, the exact diagnostic accuracy of Charcot's triad still remains unclear. Prompt diagnosis of AC is essential given the high mortality associated with severe disease, which is made more favourable when optimal treatment is implemented.7
Despite advances in medicine, there is no universally recognized gold standard for the diagnosis of AC.1 In addition, treatment pathways differ significantly depending on the severity of the disease, which is also difficult to assess clinically.1 In view of this, other diagnostic algorithms have been developed, most notably the Tokyo Guidelines which were first introduced in 2007 and then revised in 2013.6
In studies assessing the accuracy of the Tokyo Guidelines, it is clear that further improvements are required to achieve the desired effect of this diagnostic tool in practice.5 In contrast to the Tokyo Guidelines, Charcot's triad is widely recognized, simple and does not rely on laboratory data, so may still have an important role in the clinical workup of AC patients. The purposes of this review are to establish the sensitivity and specificity of Charcot's triad in the diagnosis of AC, and better characterize the utility of the triad as a diagnostic tool in practice.
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