New classifications of severity of acute pancreatitis: Validation of determinant-based and revision of the Atlanta classification

Acute Pancreatitis: Too Many Classifications—What Is a Clinician or Researcher To Do?

“…Distribution of severity categories in Acevedo-Piedra et al study 8 - (A) Revision of the Atlanta Classification (RAC); (B) Determinant Based Classification (DBC).…”

“…Due to small number of patients in severe and critical categories, the lack of statistical significance for subgroup comparisons between RAC and DBC categories in the Acevedo-Piedra et al study 8 is expected. For example, using 40% prevalence of an outcome, a sample size of roughly 90 and 375 patients in each group is needed to detect a 20% or 10% reduction in outcome, respectively, with a power of 80% and an α of 0.05.…”

“…The report by Acevedo-Piedra et al in this issue of the journal 8 evaluates performance of the original Atlanta classification, RAC and DBC in the same cohort of AP patients. The authors retrospectively applied these classification systems to 543 episodes of AP in 459 adult patients admitted to their institution during a five year period.…”

“…Therefore, collaborative effort of multiple centers is needed to achieve sample sizes for appropriate subgroup comparisons (between or within subpopulations of moderate and severe categories). Extrapolation of data from the Acevedo-Piedra et al study 8 to a larger population (e.g. the annual number of AP cases in the US) 9 provides a broader context of the expected number of patients and individual outcomes.…”