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Comparative Evaluation Of Radiologic And Clinical Scoring Systems In Early Prediction Of Severity In Acute Pancreatitis

Author: 
Junior Sundresh, N. and Dr. Narendran, S.
Subject Area: 
Health Sciences
Abstract: 

Background: Acute pancreatitis refers to an acute inflammatory process of the pancreas with a variable clinical course. It is a serious disease with high morbidity and mortality rates. So early identification of clinically severe acute pancreatitis (AP) is critical for the triage and treatment of patients. The aim of this study was to compare the accuracy of various scoring systems for predicting the severity of AP on admission. Methods: The study was prospectively carried out on 50 patients attending the surgical emergency ward with clinical features of Acute Pancreatitis in our instititution. They were evaluated clinically and subjected to laboratory and radiological investigations as per the designed Performa. Ranson’s criteria, Acute Physiology and Chronic Health Evaluation (APACHE)-II, and bedside index for severity in acute pancreatitis (BISAP) scores, and computed tomography severity index (CTSI) of all patients were calculated. The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve (AUC). Results: From a total of 50 patients included in the study, 32 were diagnosed with mild to moderately severe acute pancreatitis and 18 with severe pancreatitis and two patients with severe pancreatitis died during the hospital stay. The study reveals that when CTSI ≥ 3 was selected for prediction of severe AP, sensitivity and specificity were 55.9% and 63.8%, respectively and BISAP score of more than 2 has sensitivity 86% and specificity 69% and the sensitivity and specificity of Ranson’s score was 95% and 44.3% respectively. APACHE-II score is the more effective scoring tool than the other scoring systems, although no statistically significant pair-wise differences were observed between APACHE-II and other scoring systems. Conclusion: The various scoring systems to evaluate the severity of acute pancreatitis included in the study showed similar predictive accuracy. Hence unique models are required to achieve further improvement of prognostic accuracy in acute pancreatitis.

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