Validating the 5Fs mnemonic for cholelithiasis: time to include family history

Bass, Gary Alan; Gilani, Syeda Nadia Shah; Walsh, T. N.; Leader, F.

doi:10.1136/postgradmedj-2012-131341

Cited by 14 publications

(6 citation statements)

References 13 publications

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“…Gallstone ileus is more prevalent in women than men (ratio of 1:3–7) [ 3 , 4 , 6 – 8 ] and those of Caucasian ancestry (accounting for 66.5% of gallstone ileus patients) [ 9 ]. These figures reflect the old adage taught at all Medical Schools regarding the prevalence of gallstones: Five F’s for “fat, female, fair, fertile and (over) forty (in age)” [ 10 ]. The incidence of gallstone ileus is increasing, and this is likely due to the aging population, and better awareness and diagnosis of the condition.…”

Section: Introductionmentioning

confidence: 67%

“…The mortality of gallstone ileus ranges in the literature from 7 to 30% (average 18%) [ 4 , 8 , 9 , 11 – 15 ]. This high mortality is attributed to unmodifiable factors such as elderly or frail population, multiple comorbidities, particularly cardiovascular, respiratory, and endocrine (diabetes and obesity), as well as late presentation from the onset of symptoms (average 4–8 days) [ 9 , 10 ] or delayed diagnosis. The literature generally describes a median delay between admission and surgical intervention of 2–37 days (range 1–15 days) [ 5 , 9 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and radiological diagnosis of gallstone ileus: a mini review

et al. 2017

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Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.

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Section: Introductionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Clinical and radiological diagnosis of gallstone ileus: a mini review

et al. 2017

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“…Acknowledging acute complicated calculous biliary disease (ACCBD) as a common set of clinical problems presented to general surgeons, the Cohort Studies Group of the European Society for Trauma and Emergency Surgery (ESTES) set out to capture real-world data on the epidemiology, and contemporary management of these patients [17,18]. Traditional medical school teaching identifies the 6Fs (fair, fat, fertile, female, forty, and family history) as phenotypic predictors of symptomatic gallstone disease [19]. Notably, however, the cohort presenting to European emergency departments with acute complicated biliary calculous conditions were older than this teaching suggests, with a median age of 67 years [17,18].…”

Section: Introductionmentioning

confidence: 99%

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

et al. 2021

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Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p < 0.001). Surgical complications were more frequent in the ≥ 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients ≥ 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or post-discharge rehabilitation need. Conclusions Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment. Trial Registration ClinicalTrials.gov (Trial # NCT03610308).

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“…management of these patients [18,19]. While traditional medical school teaching identi es the 6Fs (fair, fat, fertile, female, forty and family history) as predictors of the population most likely to present with symptomatic gallstone disease [20], it was notable that the cohort presenting to European emergency departments were older, with a median age of 67 years.…”

Section: Introductionmentioning

confidence: 99%

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

Bass¹,

Gillis²,

Cao³

et al. 2020

Preprint

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Background: Acute complicated calculous biliary disease (ACCBD) may pose challenges in an ageing population. Frailty and comorbidities increase the potential risks of surgery; thus, surgeons may opt to offer operative treatments less often to their older patients. We set out to capture the incidence and treatment algorithms used across Europe to treat older patients presenting with ACCBD.Methods: Analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Acute Complicated Calculous Biliary Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. The primary outcome measure was operative intervention in patients over and under 65 years of age. Mortalities, post-operative morbidity, time to operative intervention, post-acute disposition and length of hospital stay were measured as secondary outcomes.Results: The median age of the 338 patients admitted to the snapshot was 67 years; 185 patients (54.7%) were over 65 years at time of admission. Significantly fewer patients over 65 underwent definitive surgical treatment, compared with those under 65 (37.8% vs. 64.7%, p <0.001). Surgical complications were seen more frequently in the over 65 cohort. Post-operative mortality was seen in 2.2% of over 65s versus 0.7% under 65(p=0.253). Mean post-operative length of stay was significantly longer in the elderly cohort. In patients surviving to discharge, post-acute convalescence or rehabilitation was required in 13.3% in the elderly cohort versus 1.9% of those under 65 (p=0.002).Conclusions: Elderly patients commonly present with ACCBD. Increased frailty and incidence of comorbid disease in this population increases the potential surgical risk. In our snapshot, elderly patients represented the majority, but far fewer were offered definitive surgical treatment. Post-operative mortality, morbidity, length of post-operative in-hospital stay and the requirement for post-discharge convalescence were higher in this group.

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Validating the 5Fs mnemonic for cholelithiasis: time to include family history

Cited by 14 publications

References 13 publications

Clinical and radiological diagnosis of gallstone ileus: a mini review

Clinical and radiological diagnosis of gallstone ileus: a mini review

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

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