A prospective comparison of 3 scoring systems in emergency department patients with acute pancreatitis

Background: Early identification of severe cases of acute pancreatitis is necessary and very important to reduce mortality. There are many scoring systems including BISAP, Imrie, and Balthazar scores which reported to be useful for assessment of clinical severity and prognosis. However, data regarding the prognostic significance of these scoring systems in emergency department (ED) setting are quite limited. Objective: This study aims to calculated and compared the diagnostic performance of the aforementioned scoring systems in predicting severe acute pancreatitis (SAP). Material and Methods: This prospective, observational, single-center, and cross-sectional study was conducted at ED of Celal Bayar University Hafsa Sultan Hospital in Manisa, between April 1, 2014, and July 31, 2015. Demographic and clinical parameters as well as clinical outcomes were established. All adult patients (≥18 years) underwent follow-up evaluations 30 days after admission. The primary endpoint was severe acute pancreatitis. The secondary outcomes of interest were hospital admission, intensive care unit admission, length of stay in hospital, and all-cause mortality. Predictive accuracy of the scoring systems was measured by the area under the receiver-operating curve (AUC). Results: A total of 150 patients (mean age, 66.7 ± 15.8 years; 66.1% men) with AP were enrolled in this study. Of the 150 patients, 25 (16.6%) were classified as having severe acute pancreatitis. AUCs for BISAP, Imrie, and Balthazar predicting severe pancreatitis were 0.868, 0.801, and 0.568, respectively. The best cut-off value of BISAP scoring system was 2 ( AUC 0.868, %95 [CI], 0.784-0.952, P<.001). The best cut-off value of Imrie scoring system was 2 (AUC 0.801, %95 [CI], 0.701-901, P<.001). Conclusions: The BISAP and Imrie scoring systems have good predictive value for assessing the SAP, and thus are useful for severity assessment of acute pancreatitis at the early stage of ED presentation. However, the Balthazar scoring system showed low sensitivity and specificity for assessing the SAP. Key Words: Acute pancreatitis, severe acute pancreatitis, emergency department, scoring system