DeBanto et al identified factors associated with a severe outcome for pediatric patients with acute pancreatitis. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Kentucky, University of Cincinnati, University of Pittsburgh, St. Louis University, Rush-Presbyterian-St. Luke's Medical Center and the Cleveland Clinic.
Patient selection: infant to 16 year old with acute pancreatitis
Outcome: severe pancreatitis (fatal, required surgery, pseudocyst, abscess or positive Atlanta criteria for organ dysfunction)
Parameters:
(1) age in years
(2) weight in kilograms
(3) admission white blood cell (WBC) count
(4) admission serum LDH concentration
(5) trough serum calcium at 48 hours
(6) trough serum albumin at 48 hours
(7) rise in serum BUN at 48 hours
(8) rate of fluid sequestration by 48 hours in mL per kg per 48 hours
|
Parameter |
Finding |
Points |
|
age in years |
< 7 years of age |
1 |
|
|
>= 7 years of age |
0 |
|
weight in kilograms |
< 23 kilograms |
1 |
|
|
>= 23 kilograms |
1 |
|
admission WBC count |
<= 18,500 per µL |
0 |
|
|
> 18,500 per µL |
1 |
|
admission serum LDH |
<= 2,000 IU/L |
0 |
|
|
> 2,000 IU/L |
1 |
|
trough serum calcium at 48 hours |
< 8.3 mg/dL |
1 |
|
|
>= 8.3 mg/dL |
0 |
|
trough serum albumin at 48 hours |
< 2.6 g/dL |
1 |
|
|
>= 2.6 g/dL |
0 |
|
rise in serum BUN at 48 hours |
<= 5 mg/dL |
0 |
|
|
> 5 mg/dL |
1 |
|
rate of fluid sequestion at 48 hours |
<= 75 mg/kg |
0 |
|
|
> 75 mg/kg |
1 |
where:
• The method for reporting fluid sequestration was not given but could be related to an increase in body weight.
total number of adverse findings =
= SUM(points for all 8 parameters)
Interpretation:
• minimum number: 0
• maximum number: 8
• The chances of a severe outcome increases with the number of adverse factors present.
• A score >= 3 was used to identify a patient at risk for a severe outcome.
Performance:
• The sensitivity was 70% and specificity 79%. The negative predictive value was 91% but the positive predictive value was only 45%.
Specialty: Gastroenterology
