Steva Rumsey1, Joel Winders1, Andrew D MacCormick1,2. 1. Department of Surgery, University of Auckland, Auckland, New Zealand. 2. Department of Surgery, Middlemore Hospital, Auckland, New Zealand.
Abstract
BACKGROUND: Charcot's triad is a well-established diagnostic tool for acute cholangitis (AC). It has been recognized as an inaccurate test in clinical practice; however, its exact sensitivity and specificity remain unclear. This knowledge is key to informing the value of its continued clinical application. The objectives of this study are to calculate an estimate of the sensitivity and specificity of Charcot's triad based on published research and consider its applicability to clinical practice and medical education. METHODS: Electronic database search for relevant literature and review of reference lists of the subsequent articles for additional resources. Two independent researchers located articles which were qualitatively and quantitatively reviewed. The overall sensitivity and specificity values across all studies were subsequently calculated. RESULTS: The 16 articles included in the review varied widely in study design and the sensitivity of Charcot's triad was reported for AC. Across the included articles, there were 4288 patients studied. The overall sensitivity for Charcot's triad was calculated as 36.3%. The specificity was only analysed in three studies and had an overall value of 93.2%. Nine of the articles also investigated the sensitivity of Reynold's pentad which was consistently low with an overall value of 4.82%. The specificity of Reynold's pentad was not studied. CONCLUSION: Charcot's triad has limited clinical utility as a diagnostic algorithm for AC. It is an effective rule-in test but a poor rule-out test and should be applied and taught accordingly. A more sensitive diagnostic tool is required to achieve superior outcomes for AC patients.
BACKGROUND: Charcot's triad is a well-established diagnostic tool for acute cholangitis (AC). It has been recognized as an inaccurate test in clinical practice; however, its exact sensitivity and specificity remain unclear. This knowledge is key to informing the value of its continued clinical application. The objectives of this study are to calculate an estimate of the sensitivity and specificity of Charcot's triad based on published research and consider its applicability to clinical practice and medical education. METHODS: Electronic database search for relevant literature and review of reference lists of the subsequent articles for additional resources. Two independent researchers located articles which were qualitatively and quantitatively reviewed. The overall sensitivity and specificity values across all studies were subsequently calculated. RESULTS: The 16 articles included in the review varied widely in study design and the sensitivity of Charcot's triad was reported for AC. Across the included articles, there were 4288 patients studied. The overall sensitivity for Charcot's triad was calculated as 36.3%. The specificity was only analysed in three studies and had an overall value of 93.2%. Nine of the articles also investigated the sensitivity of Reynold's pentad which was consistently low with an overall value of 4.82%. The specificity of Reynold's pentad was not studied. CONCLUSION: Charcot's triad has limited clinical utility as a diagnostic algorithm for AC. It is an effective rule-in test but a poor rule-out test and should be applied and taught accordingly. A more sensitive diagnostic tool is required to achieve superior outcomes for AC patients.
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