“Validation of a new American Association for the Surgery of Trauma (AAST) anatomic severity grading system for acute cholecystitis.”

Background The American Association for the Surgery of Trauma (AAST) established anatomic grading to facilitate risk stratification and risk adjusted outcomes in emergency general surgery. Cholecystitis severity was graded based on clinical, imaging, operative, and pathologic criteria. We aimed to validate the AAST anatomic grading system for acute cholecystitis. Methods This is a retrospective cohort study including consecutive patients admitted with acute cholecystitis at an urban, tertiary medical center between 2013 and 2016. Grade I is acute cholecystitis, Grade II is gangrenous or emphysematous cholecystitis, Grade III is localized perforation, Grade IV and V have regional and systemic peritonitis, respectively. Concordance between the AAST grade and outcome including mortality, length of stay (LOS), ICU use, readmission, and complications were assessed using logistic regression. Results A total of 315 patients were included. There was very good interrater (2 independent raters) reliability for anatomic grading, κ=1.00, p

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