Acute Pancreatitis: Updates for Emergency Clinicians

Waller, Anna; Long, Brit; Koyfman, Alexander; Gottlieb, Michael

doi:10.1016/j.jemermed.2018.08.009

Cited by 66 publications

(77 citation statements)

References 115 publications

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“…The incidence of acute pancreatitis has been increasing worldwide, and while multiple risk stratifying tools have previously been developed, they come with limitations. 1,2,[7][8][9] The 3 most commonly used risk strati cation tools in the ED include the BISAP score, the APACHE II Scoring System, and the Ranson's criteria. 1 Imaging-based scores also exist, which grade computed tomography ndings of pancreatitis, but may not be performed routinely and may underestimate severity in patients who present early in the disease course.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,[7][8][9] The 3 most commonly used risk strati cation tools in the ED include the BISAP score, the APACHE II Scoring System, and the Ranson's criteria. 1 Imaging-based scores also exist, which grade computed tomography ndings of pancreatitis, but may not be performed routinely and may underestimate severity in patients who present early in the disease course. 14,[19][20][21] While these scoring systems are regularly used to predict mortality, they were not designed speci cally for utility in the ED.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

Miller

Safa

et al. 2020

Preprint

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Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

Miller

Safa

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…1,2,7−9 The 3 most commonly used risk strati cation tools in the ED include the BISAP score, the APACHE II Scoring System, and the Ranson's criteria. 1 Imaging-based scores also exist, which grade computed tomography ndings of pancreatitis, but may not be performed routinely and may underestimate severity in patients who present early in the disease course. 14,19−21 While these scoring systems are regularly used to predict mortality, they were not designed speci cally for utility in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the incidence of acute pancreatitis has risen worldwide, with results from a retrospective analysis in the US showing a 13% increase in hospital admissions over 10 years. 1,2 The annual incidence of acute pancreatitis in the US ranged from 13 to 45 per 100,000 people. 3 While most patients who present with acute pancreatitis in the emergency department (ED) achieve positive outcomes, signi cant morbidity and mortality still exists.…”

Section: Introductionmentioning

confidence: 99%

Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

Miller

Safa³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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“…Although most of these patients recover without any sequelae, about 10% to 20 % of patients may have a severe attack of acute pancreatitis, even with a mortality of 20% (3,4) . Worldwide, gall stones are commonly known to precipitate acute pancreatitis, however studies in India reflect alcohol intake as a more common etiology (5,6) . As alcohol intake is a frequent menace precipitating acute pancreatitis, severity of acute pancreatitis must be pre-assessed and physician must be ready to face any outcome.…”

Section: Introductionmentioning

confidence: 99%

Different Scoring Systems in Acute Alcoholic Pancreatitis: Which One to Follow? An Ongoing Dilema

Jain

Bhaduri

Jain

2019

Arq. Gastroenterol.

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BACKGROUND: Acute pancreatitis is a common disorder in medical practice. In recent times, management has changed drastically with majority of decisions like intravenous antibiotics, negative suction with Ryle’s tube and surgical interventions like necrosectomy etc based on severity of the disease. There are different scores in use to assess severity of disease but the relative efficacy has remained a debatable subject. OBJECTIVE: The present study was thus done to investigate the predictive accuracy of different scoring systems in acute pancreatitis. METHODS: Fifty patients of acute pancreatitis admitted in medicine ward of Pt. B.D. Sharma PGIMS, Rohtak, India, were taken for study after fulfilling eligibility criteria. These patients were investigated at admission and followed up prospectively. The severity of pancreatitis was classified for each of these patients as per Revised Atlanta System of Classification. Commonly used scoring systems pertaining to acute pancreatitis, viz, BISAP, Ranson, APACHE II and modified computed tomography severity index (CTSI) were calculated. Subsequently these scores were then correlated with severity, presence of organ failure, occurrence of local complications and final outcome of the patients. RESULTS: Out of 50 patients, etiology was chronic alcohol intake in all but one with idiopathic pancreatitis. The mean age of the study population was 42.06±13.27 years. 32% of these patients had pancreatic necrosis, 40% had peripancreatic collections. 56% of them had mild acute pancreatitis, 24% had moderately severe acute pancreatitis, while 20% had severe acute pancreatitis. APACHE II had the highest accuracy in predicting severity, organ failure and fatal outcomes. As far as these parameters were concerned, the negative predictive values of BISAP score were also considerable. Modified CTSI score was accurate in predicting local complications but had limited accuracy in other predictions. CONCLUSION: APACHE II emerged as most reliable scoring system followed by BISAP and Ranson in management of the patients with acute pancreatitis. But in constraints of time and resources, even BISAP score with its significant negative predictive values served as a valuable tool for assessing and managing these patients.

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Acute Pancreatitis: Updates for Emergency Clinicians

Cited by 66 publications

References 115 publications

Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

Different Scoring Systems in Acute Alcoholic Pancreatitis: Which One to Follow? An Ongoing Dilema

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