Tuesday, August 17, 2010

Severity assessment in acute pancreatitis

Multiple reviews of pancreatitis emphasize severity assessment because several management decisions hinge on it. Several severity scoring tools are available. Their use is somewhat cumbersome because different tools are applicable in different situations. Some are useful on day one while others cannot be used until 48 hours. Since each tool has advantages and disadvantages, multiple tools may be needed for most effective use so I thought it would be helpful to have links to the major ones here in one place.

Ranson's score. Pro---tried and true, and in my anecdotal experience uncannily predictive. Con---can't be completed until 48 hours.

APACHE II. Pro---well validated in pancreatitis, can be used daily. Con---a little cumbersome to use.

BISAP score. Pro---easy to use, can be used in the first 24 hours. Con---not as well validated as some of the other scores, needs further research.

CT scores (no Internet table or calculator found; resource here). Pro---clinically validated. Con---cumbersome; not generally available on day 1 or daily; IV contrast preferred.

Atlanta criteria (no Internet calculator found, but resource here). Pro---can be used any time during the patient's course; any single criterion on the list defines pancreatitis as severe. Con---relies on other scores and assessment tools.

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