The best scale for predicting poor prognosis in pancreatitis
Date First Published:
June 21, 2006
Last Updated:
July 19, 2006
Report by:
Charleen Liu, Medical Student (Manchester Royal Infirmary)
Three-Part Question:
In [patients with acute pancreatitis], is [Ranson's criteria or Glasgow criteria] best in [predicting the need for intensive care admission]?
Clinical Scenario:
A 48 year old woman presented to the accident and emergency department with severe epigastric pain radiating to the back. Acute pancreatitis was diagnosed. You wonder if Ranson's criteria or Glasgow criteria is better in predicting the need for referring her to the intensive care unit.
Search Strategy:
Medline and EMBASE and CINAHL 1966 to June Week 4 2006 using Ovid Interface.
Search Details:
([pancreatitis.mp. or exp Pancreatitis, Acute Necrotizing/ or exp Pancreatitis/ or exp Pancreatitis, Alcoholic/] AND [exp "Severity of Illness Index"/ or ranson.mp.] AND [(glasgow adj3 criteria).mp. [mp=title, original title, abstract, name of substance word, subject heading word] OR [modified imrie.mp. or exp "Severity of Illness Index"/]] limit to human, English language and all adult(19 plus))
Outcome:
373 papers were found in total, of which 3 were relevant. They are shown in the table below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Predictors of severity of acute pancreatitis. Steinberg WM 1990 | Review article | Full journal article awaiting. No abstract. | |||
| Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis. Williams, M. Simms, HH 1999 USA | 273 patients' charts with discharge code 'pancreatitis' were reviewed between 1992 and 1996. | Prognostic study | Length of hospital stay | Ranson: correlation=0.68, p=0.03 | Full article awaiting |
| Modified Glasgow: correlation=0.78, p=0.007 | |||||
| Conclusion: Modified Glasgow has a slightly larger correlation with the length of hospital stay | |||||
| Prognostic indicators in acute pancreatitis. Imrie, Clement W 2003 UK | Review article | Full article awaiting |
Author Commentary:
Ranson's criteria and Modified Glasgow scale are both useful prognostic tools for acute pancreatitis. Out of the 3 papers found, 2 were review articles, only one was a prognostic study. More studies comparing Ranson's criteria and Glasgow Scale are needed to be done in order to give reliable answer to this question.
Bottom Line:
The Modified Glasgow scale has a slightly stronger association with predicting the length of hospital stay from the above study.
References:
- Steinberg WM. Predictors of severity of acute pancreatitis.
- Williams, M. Simms, HH. Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis.
- Imrie, Clement W. Prognostic indicators in acute pancreatitis.