A comparative evaluation of radiologic and clinical scoring systems in early prediction of severity in acute pancreatitis

BACKGROUND: Demographic, clinical, and laboratory data of all consecutive patients with a primary diagnosis of ACUTE PANCREATITIS during a one year period is prospectively collected for this study. A retrospective analysis of the abdominal CT data is performed. CT severity index as well as two clinical scoring systems: Glasgow criteria / IMRIE’S prognostic criteria and Bedside Index for Severity in Acute pancreatitis (BISAP) were comparatively evaluated with regard to their ability to predict the severity of acute pancreatitis on admission (within 48 h of hospitalization). First 50 patients attending the surgical emergency ward with clinical features of Acute Pancreatitis are evaluated clinically and subjected to laboratory and radiological investigations as per the designed proforma. Data pertinent to the scoring systems will be recorded within 48hr of admission to the hospital. Once diagnosis is established the patient disease severity will be assessed by following the scoring systems CT SEVERITY INDEX, MODIFIED GLASGOW, BISAP. The accuracy of each imaging and clinical scoring system for predicting the severity of AP was assessed using appropriate statistical tools. RESULTS: On keeping the cut of value for BISAP as 3, GLASGOW as 3 AND CTSI as 4 and analyzing using PEARSON CORRELATION it was found BISAP had 82.6% correlation compared to GLASGOW and CTSI which only had 51.4% correlation. If BISAP score predicts the disease to be severe then there is 82% positivity that the patient will have acute severe pancreatitis. In CRAMER V test the strength of association was found to be 0.826 for BISAP score which is very high for predicting complications. In other words only 23.6% of people with negative BISAP score will have complication. The strength of association for Glasgow and CTSI was 0.514 which is moderate association and there is 64.7% chance of false negativity with these scoring systems. CONCLUSION: From this study, we conclude that the BISAP score could be a simple and better clinical scoring system for the evaluation of disease severity in acute pancreatitis than GLASGOW and CTSI.