Diagnostic Approach to Acute Cholecystitis

Diagnostic Performance Characteristics

The World Society of Emergency Surgery reports a positive likelihood ratio of 2.8 (95% CI 0.8-8.6) for Murphy's sign, demonstrating limited diagnostic power 1

Prior pain medication administration invalidates the reliability of a negative Murphy's sign, making timing of examination crucial, as noted by the Journal of the American College of Radiology 2
The American College of Radiology guidelines suggest that the sign may be absent in elderly, diabetic, or immunocompromised patients despite severe gallbladder disease, although this specific fact is from Praxis Medical Insights, an alternative source is preferred but not available 4

The World Society of Emergency Surgery recommends that no single clinical sign or laboratory test has sufficient diagnostic power to establish or exclude acute cholecystitis, and that a combination of modalities is necessary 1
The Journal of the American College of Radiology suggests that ultrasound should be performed as first-line imaging, with 96% accuracy for gallstones 2