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Predictive value of scoring system based on clinical, biochemical and imaging findings in the diagnosis of common bile stones
ABSTRACT: A prospective study was undertaken to find out the Predictive Value of scoring system based on clinical, biochemical and imaging findings in the diagnosis of Common Bile Duct stones. The study was carried out over-a period of twelve months in the Department of Surgery with support from Department of Radiology and Pathology of Bir Hospital and Patan Hospital. Thirty-three patients of symptomatic gallstone disease along with the risk factors for common bile duct stones were included in this study. Risk factors were incorporated to scoring system and prediction of prediction of presence or absence of common bile duct stone was done. Diagnosis was confirmed on the basis of ERCP and or Preoperative Cholangiogram findings.. Diagnostic value was confirmed with operative findings. Gold standard for the presence or absence of CBD stones was operative finding. In the univariate analysis presence USG, the predictive value was sensitivity 65%, specificity 76%, PPV81%, NPV58% respectively. The predictive value of ERCP for CBD stone was 100% sensitive,, specificity was 88%, PPV was 91%, NPV was 100% respectively. Similarly, Intraoperative cholangiogram was very sensitive. The predictive value of Intraoperative cholangogram for CBD stone was 100%. As the score was more than three, the predictive value of sensitivity was 95%, specificity was 15%, PPV was 65%, NPV was 66% respectively. One patients was found stone positive with score less than three but the size of the CBD stone was only 4mm in size. By using scoring system, which is very simple to apply, and sensitive to predict CBD stone can be used to perform selective intra operative cholangiogram of ERCP to confirm the diagnosis, thereby reducing the negative exploration of CBD.