How to score acute pancreatitis in the emergency setting: five systems against ED-SAS

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Confidence Interval ◽  
Scoring Systems ◽  
Apache Ii ◽  
Youden Index ◽  
Automation System ◽  
Emergency Setting ◽  
Death Rates ◽  
Significant Difference

To assess the effectiveness of a new scale known as “Emergency department SpO2 (peripheral capillary oxygen saturation), age, and SIRS (Systemic inflammatory response syndrome)” (ED-SAS) that can be used to predict prognosis within 24 hours following presentation compatible with acute pancreatitis in patients admitted to the emergency department. This research project was conducted as a single-center, retrospective, cohort study. The Acute Physiology and Chronic Health Evaluation II (APACHE II), SIRS, Bedside Index for Severity in Acute Pancreatitis (BISAP), ED-SAS, modified Glasgow Scale and Ranson criteria scoring of the patients were evaluated using their presentation data screened from the hospital automation system. Then, the efficiencies of these evaluation systems were compared using the receiving operating curve (ROC). The conformity of the data to the normal distribution was checked with the Kolmogorov-Smirnov test. The ROC analyses were employed to identify the cut-off values of the scoring systems in calculating death rates. The method developed by DeLong et al. was used to compare the ROC curves of the scoring systems. The study has been completed with 235 patients, 91 (38.7%) male and 144 (61.3%) female, with a mean age of 63.1 ± 17.7 years. In the ROC analysis of the ED-SAS evaluation tool to predict death rates, the area under the curve (AUC) value was found to be 0.85 (95% confidence interval: 0.79–0.89), and the Youden index was 0.62, with a p value of 0.001. Mortality prediction with ED-SAS significantly differed compared to the Ranson and SIRS scoring systems (P = 0.001 and P = 0.03, respectively). However, no statistically significant difference was found in the comparison of the ED-SAS score with the modified Glasgow and APACHE II scores (P = 0.12 and P = 0.54, respectively). It was concluded that the Baseband ED-SAS scores provided equally significant results in terms of AUC at the 95% confidence interval (P = 0.05). Statistical analyses revealed that the APACHE II, SIRS, BISAP, modified Glasgow and ED-SAS scores were found to be significantly higher among the dead in comparison to the survivors (P < 0.05). ED-SAS constitutes a simple, fast, expedient and effective evaluation system that can be utilized to predict mortality in acute pancreatitis in the emergency setting.

scholarly journals Evaluation of Ranson’s Score, Glasgow, Apache II, Apache O, Balthazar CTSI in Acute Pancreatitis Patients

2020 ◽  
Vol 3 (1) ◽  
pp. 132-135
Author(s):  
Vijaykumar C Bada ◽  
K Ravindranath
Keyword(s):  
Acute Pancreatitis ◽  
Scoring Systems ◽  
Apache Ii ◽  
Study Group ◽  
Biliary Pancreatitis ◽  
Severe Pancreatitis ◽  
Significant Difference

Background: Pancreatitis is an inflammation of the glandular parenchyma leading to injury or destruction of acinar components. This study was conducted to evaluate Ranson’s score, Glasgow, APACHE II, APACHE O, Balthazar CTSI in acute pancreatitis patients. Subjects and Methods: This study was conducted at Department of surgical Gastroenterology, Global hospital Hyderabad to evaluate Ranson’s score, Glasgow, APACHE II, APACHE O, Balthazar CTSI in acute pancreatitis patients. Results: 34% of the patients in the study were aged 31-40 years and only 6% of the patients were aged >60 years. The etiologic factors for acute pancreatitis in the study group included alcoholism (n= 27, 50.94%), Idiopathic (n=15, 28.30%), biliary pancreatitis (n= 10, 18.87%) and hypertriglyceridemia (n=1, 1.89%). A significant difference in all scoring systems was found between cases of mild and severe pancreatitis (P< 0.05). Among the multifactor scoring systems, Ranson’s was found to be a better predictor than APACHE-II. There was not much difference between APACHE-O and APACHE-II. Overall, CTSI found to be the best predictor, followed by APACHE-II. Conclusion: The authors found that there was no significant difference among the multifactor scoring systems, although Glasgow and APACHE-II fare better.

scholarly journals Adolescents’ pain and distress during peripheral intravenous cannulation in a paediatric emergency setting

2021 ◽  
Author(s):  
Giorgio Cozzi ◽  
Marta Cognigni ◽  
Riccardo Busatto ◽  
Veronica Grigoletto ◽  
Manuela Giangreco ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Local Anaesthesia ◽  
Cross Sectional Study ◽  
Emergency Setting ◽  
Older Children ◽  
Cross Sectional ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Significant Difference

AbstractThe objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used

scholarly journals Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality

2018 ◽  
Vol 5 (11) ◽  
pp. 3707 ◽  
Author(s):  
Nishith M. Paul Ekka ◽  
Gaurav Mishra ◽  
Vinod Kumar ◽  
Arun Kumar Tiwary ◽  
Tanushree Kar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Hospital Admissions ◽  
Scoring Systems ◽  
Apache Ii ◽  
Aetiological Factor ◽  
Serum Lipase ◽  
Clinical Pattern ◽  
Local Complications ◽  
Complications And Mortality

Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.

Comparison of Ranson, APACHE II and APACHE III Scoring Systems in Acute Pancreatitis

Pancreas ◽  
2002 ◽  
Vol 25 (4) ◽  
pp. 331-335 ◽  
Author(s):  
Constantinos Chatzicostas ◽  
Maria Roussomoustakaki ◽  
Ioannis G. Vlachonikolis ◽  
Georgios Notas ◽  
Ioannis Mouzas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Scoring Systems ◽  
Apache Ii ◽  
Apache Iii

scholarly journals Ureteric obstruction as an unrecognised cause of acute pancreatitis in the emergency setting

2009 ◽  
Vol 7 (1) ◽  
Author(s):  
Mariolyn Raj ◽  
Spencer Murray
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Unusual Case ◽  
Accurate Diagnosis ◽  
Emergency Setting ◽  
Severity Assessment ◽  
Ureteric Obstruction ◽  
Acute Setting ◽  
Severe Pancreatitis ◽  
Possible Cause

Introduction Acute severe pancreatitis has a high mortality rate (10 to 30 %) and the aetiology of the pancreatitis itself influences the severity assessment and ultimately the treatment.1 Up to 20% of cases of acute pancreatitis are said to be due to unusual causes such as viral infection, trauma and drugs. However to date, there have been no reports in the literature of ureteric obstruction and infection causing acute pancreatitis. Methods We report on a case of a 77-year-old male who presented to the Emergency Department with acute pancreatitis occurring in the setting of an obstructed and infected right urinary system. Results We outline the pathway to diagnosis and management in this patient and highlight the difficulties associated with reaching an accurate diagnosis in the acute setting. Conclusion We report on this unusual case of acute pancreatitis in the emergency setting. By illustrating this case we aim to promote awareness of and encourage clinicians to consider ureteric obstruction as a possible cause of acute pancreatitis, in their workup of patients in the emergency department.

scholarly journals Evaluation of Different Scoring Systems in Predicting the Severity of Acute Pancreatitis

2020 ◽  
Vol 7 (45) ◽  
pp. 2604-2610
Author(s):  
Rohan J. Harsoda ◽  
Sharma Vipin Jaishree ◽  
Krishna Prasad G.V
Keyword(s):  
Acute Pancreatitis ◽  
Scoring System ◽  
Scoring Systems ◽  
Apache Ii ◽  
Prediction Of Outcome ◽  
Poor Outcome ◽  
Increased Risk ◽  
Highly Sensitive ◽  
Poor Outcomes ◽  
Ranson Score

BACKGROUND Accurate prediction of the severity of acute pancreatitis will help in identifying patients at increased risk for morbidity and mortality. We wanted to evaluate the different scoring systems in predicting the severity of acute pancreatitis. METHODS This cross-sectional study was undertaken in the Department of Surgery at a zonal hospital between April 2013 and December 2014. RESULTS 40 patients were selected and enrolled in the study as per the selection criteria. 20 (50 %) patients had fair outcome and 20 (50 %) had a poor outcome. Accuracy of different scoring systems in predicting patient outcome ranged from 45 % (48-hr APACHE II) to 62.5 % (Goris MOF at baseline and 48 hr). Baseline Goris MOF was 70 % sensitive and 55 % specific in prediction of poor outcome. It had an accuracy of 62.5 % in prediction of outcome. 48-hr Goris MOF was 80 % sensitive and 45 % specific in predicting the outcome. Baseline APACHE II scores were below the cut-off level in all the patients. 48-hr APACHE II scores were 5 % sensitive and 100% specific for prediction of outcome. Ranson score > 3 was 25 % sensitive and 90 % specific in the prediction of outcome. Balthazar score > 6 was 65 % sensitive and 55 % specific in prediction of outcome. Ranson score was found to have a limited sensitivity for different outcomes (ranging from 21.1 % to 50 %) but was found to have a high specificity (83.8 % to 90 %). CONCLUSIONS Goris scoring system (at 48 hrs) was found to be highly sensitive to different poor outcomes as well as duration of hospital stay. It also correlated with Balthazar scoring system, which was also highly sensitive to different poor outcomes studied. KEYWORDS Acute Pancreatitis, Prediction, Scoring System, APACHE II, Goris MOF, Ranson’s Score, Balthazar Score

scholarly journals Performance of Prognostic Scoring Systems in Trauma Patients in the Intensive Care Unit of a Trauma Center

2020 ◽  
Vol 17 (19) ◽  
pp. 7226
Author(s):  
Shao-Chun Wu ◽  
Sheng-En Chou ◽  
Hang-Tsung Liu ◽  
Ting-Min Hsieh ◽  
Wei-Ti Su ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Dysfunction ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Apache Ii ◽  
Trauma Patients ◽  
Saps Ii ◽  
Significant Difference ◽  
Prognostic Scoring Systems

Background: Prediction of mortality outcomes in trauma patients in the intensive care unit (ICU) is important for patient care and quality improvement. We aimed to measure the performance of 11 prognostic scoring systems for predicting mortality outcomes in trauma patients in the ICU. Methods: Prospectively registered data in the Trauma Registry System from 1 January 2016 to 31 December 2018 were used to extract scores from prognostic scoring systems for 1554 trauma patients in the ICU. The following systems were used: the Trauma and Injury Severity Score (TRISS); the Acute Physiology and Chronic Health Evaluation (APACHE II); the Simplified Acute Physiology Score (SAPS II); mortality prediction models (MPM II) at admission, 24, 48, and 72 h; the Multiple Organ Dysfunction Score (MODS); the Sequential Organ Failure Assessment (SOFA); the Logistic Organ Dysfunction Score (LODS); and the Three Days Recalibrated ICU Outcome Score (TRIOS). Predictive performance was determined according to the area under the receiver operator characteristic curve (AUC). Results: MPM II at 24 h had the highest AUC (0.9213), followed by MPM II at 48 h (AUC: 0.9105). MPM II at 24, 48, and 72 h (0.8956) had a significantly higher AUC than the TRISS (AUC: 0.8814), APACHE II (AUC: 0.8923), SAPS II (AUC: 0.9044), MPM II at admission (AUC: 0.9063), MODS (AUC: 0.8179), SOFA (AUC: 0.7073), LODS (AUC: 0.9013), and TRIOS (AUC: 0.8701). There was no significant difference in the predictive performance of MPM II at 24 and 48 h (p = 0.37) or at 72 h (p = 0.10). Conclusions: We compared 11 prognostic scoring systems and demonstrated that MPM II at 24 h had the best predictive performance for 1554 trauma patients in the ICU.

Balthazar Computed Tomography Severity Index Is Superior to Ranson Criteria and APACHE II and III Scoring Systems in Predicting Acute Pancreatitis Outcome

2003 ◽  
Vol 36 (3) ◽  
pp. 253-260 ◽  
Author(s):  
Constantinos Chatzicostas ◽  
Maria Roussomoustakaki ◽  
Emmanouel Vardas ◽  
John Romanos ◽  
Elias A. Kouroumalis
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Scoring Systems ◽  
Severity Index ◽  
Apache Ii

Severity markers in patients with acute pancreatitis

Open Medicine ◽  
2014 ◽  
Vol 9 (4) ◽  
pp. 556-564 ◽  
Author(s):  
Abdullah Kisaoglu ◽  
Bulent Aydinli ◽  
Gurkan Ozturk ◽  
Sabri Atamanalp ◽  
Bunyami Ozogul ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
High Sensitivity ◽  
Scoring Systems ◽  
Serum Levels ◽  
Apache Ii ◽  
Control Group ◽  
Correct Prediction ◽  
Total N ◽  
The Mean ◽  
The Difference

AbstractTo evaluate the effectiveness of serum levels of resistin and CD14 expression in monocytes, and high-sensitivity C-reactive protein (hsCRP) in early stages of acute pancreatitis and correct prediction of the severity of acute pancreatitis (AP) using scoring systems. The study involved 10 (29.41%) male and 24 (70.59%) female patients (total n=34) followed for AP diagnosis at the Department of General Surgery, Ataturk University Medical School between July 2008 and September 2009. In all the patients, Ranson and APACHE II scores, serum resistin, hsCRP, and monocyte CD14 expression levels were determined. The patients were divided into two groups as mild and severe AP groups. A control group was formed and the intergroup comparisons were made. Values ≥ 3 based on the Ranson scoring scale and values ≥ 8 in APACHE II scoring scale were considered to indicate severe AP. Evaluations were based on the values obtained on the 1st and 7th days for serum resistin and hsCRP levels and monocyte CD 14 expression. In 17 (50%) patients, severe AP was determined. No statistically significant differences were found between the mean serum resistin levels of AP groups, while the difference for the same parameter between the mild and severe AP groups and the control group was statistically significant. In the severe AP group, the mean 1st day and 7th day serum hsCRP levels were statistically significantly higher. The CD14 expression in monocytes was similar in all the groups. Serum hsCRP concentrations and Ranson and APACHE II scores and serum resistin and hsCRP concentrations on the 1st day were positively correlated. Serum hsCRP measurement is effective in determining the severity of acute pancreatitis. Serum resistin measurement may be a useful early marker in determining the inflammatory response in AP. However, CD14 expression in monocytes was not found to be a useful marker in the diagnosis and prediction of the disease severity in AP patients.

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