🟢 Acute Cholecystitis Severity Grading (Tokyo TG18)
This tool grades acute cholecystitis severity (I/II/III) by the Tokyo Guidelines 2018, which links grade to organ dysfunction, local inflammation, and the appropriate management pathway.
Acute Cholecystitis Severity Grading (Tokyo TG18)
Grade III (severe): any organ dysfunction — cardiovascular (dopamine ≥ 5 or any norepinephrine), neurologic (altered consciousness), respiratory (PaO₂/FiO₂ < 300), renal (oliguria or Cr > 2.0 mg/dL), hepatic (PT-INR > 1.5), hematologic (platelets < 100,000)
Grade II (moderate): any — WBC > 18,000/µL, palpable tender RUQ mass, duration > 72 h, marked local inflammation (gangrenous/emphysematous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis)
When to use
Use after diagnosing acute cholecystitis to assign a severity grade and choose between early cholecystectomy, percutaneous cholecystostomy, or organ support with urgent drainage.
How it works
Assess Grade III first (any organ dysfunction: cardiovascular/neurologic/respiratory/renal/hepatic/hematologic), then Grade II (WBC > 18,000, tender RUQ mass, duration > 72 h, or marked local inflammation); otherwise Grade I.
Key points
- Grading is evaluated top-down — rule out Grade III, then Grade II, defaulting to Grade I — so a single organ dysfunction immediately defines severe disease. (original synthesis · not guideline verbatim)
- This tool grades severity only; the diagnosis itself requires the TG18 triad of local signs, systemic inflammation, and imaging.
- Surgical timing and approach also weigh anesthetic risk (ASA/CCI) and team experience.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.