Advertisement

The ability of emergency physicians to diagnose and score acute pancreatitis on computed tomography

  • A. Karagöz
  • E. E. Ünlüer
  • O. Oyar
  • F. E. Topal
  • F. Topal
Original Article

Abstract

Purpose

The aim of this study is to determine the ability of emergency physicians’ (EP) interpreting contrast-enhanced computed tomographies (CECTs) performed in patients diagnosed or suspected acute pancreatitis (AP), using the modified computed tomography severity index (MCTSI) scoring system.

Methods

This study was conducted in Training and Research Hospital’s Emergency Department. From January 1, 2013 to April 30, 2016, patients whom performed CECT within 24 h of admission with diagnosis or suspicion of AP were reviewed retrospectively. One hundred eighteen patients were included in the study. Three-third-year EPs received education about CECT interpretation and MCTSI criteria. Each EP interpreted CECTs in a blinded manner. The EPs’ performance of determining the CECTs with or without AP and scoring the CECTs with CTSI scoring system was investigated.

Results

The agreement (weighted kappa) between the EPs and the radiologists for determining CECTs positive for AP was 0.932 (p < 0.001), 0.864 (p < 0.001) and 0.949 (p < 0.001) for EP1, EP2 and EP3, respectively. The agreement for MCTSI scores was 0.649 (p < 0.001), 0.588 (p < 0.001) and 0.734 (p < 0.001). These values showed a significant relationship between the EPs and radiologists.

Conclusions

EPs can diagnose the AP on CECTs and score CECTs with MCTSI scoring system correctly.

Keywords

Acute pancreatitis Contrast-enhanced computed tomography Emergency physician Modified CT severity index 

Notes

Compliance with ethical standards

Conflict of interest

Arif Karagöz, Erden Erol Ünlüer, Orhan Oyar, Fatih Esad Topal, and Firdevs Topal declare that they have no conflict of interest.

Ethical Statement

All of the authors declare that the manuscript, as submitted or its essence in another version, is not under consideration for publication elsewhere, and will not be published elsewhere while under consideration by European Journal of Trauma and Emergency Surgery. All authors have made substantive contributions to the study, and all authors endorse the data and conclusions. A single study is not split up into several parts to increase the quantity of submissions and submitted to various journals or to one journal over time. No data have been fabricated or manipulated (including images) to support our conclusions. No data, text, or theories by others are presented as if they were the authors’ own.

All authors have read and approved the paper, have met the criteria for authorship as established by the International Committee of Medical Journals Editors, believe that the paper represents honest work, and are able to verify the validity of the results reported. Authors whose names appear on the submission have contributed sufficiently to the scientific work, and therefore share collective responsibility and accountability for the results. The undersigned authors transfer all copyright ownership of the manuscript to the journal in the event the work is published. The undersigned authors warrant that the article is original, does not infringe upon any copyright or other proprietary right of any third party and has not been previously published.

References

  1. 1.
    Rosen MP, Sands DZ, Longmaid HE 3rd, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR. 2000;174:1391–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal diseases in the United States: 2012 update. Gastroenterology. 2012;143:1179–87.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med. 1994;330:1198–210.CrossRefPubMedGoogle Scholar
  5. 5.
    Mortele KJ, Wiesner W, Intriere L. A modified CT severity index for evaluating acute pancreatitis. AJR. 2004;183:1261–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Sharma V, Rana SS, Sharma RK, Kang M, Gupta R, Bhasin DK. A study of radiological scoring system evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in acute pancreatitis. Ann Gastroenterol. 2015;28:399–404.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Shinagare AB, Ip IK, Raja AS, Sahni VA, Banks P, Khorasani R. Use of CT and MRI in emergency department patients with acute pancreatitis. Abdom Imaging. 2015;40:272–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Papachristou GI, Clermont G, Sharma A, Yadav D, Whitcomb DC. Risk and markers of severe acute pancreatitis. Gastroenterol Clin N Am. 2007;36:277–96.CrossRefGoogle Scholar
  9. 9.
    Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223:603–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974;61:443–51.PubMedGoogle Scholar
  11. 11.
    Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984;25:1340–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Agarwal N, Pitchumoni CS. Simplified prognostic criteria in acute pancreatitis. Pancreas. 1986;1(1):69–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMedGoogle Scholar
  14. 14.
    Larvin M, McMahon MJ. APACHE II score for assessment and monitoring of acute pancreatitis. Lancet. 1989;2:201–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Johannes RS, et al. A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. Am J Gastroenterol. 2009;104(4):966–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Kuo DC, Rider AC, Estrada P, Kim D, Pillow MT. Acute pancreatitis: what’s the score? J Emerg Med. 2015;48:762–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93:738–44.CrossRefPubMedGoogle Scholar
  18. 18.
    Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. 1985;156:767–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, et al. Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. AJR Am J Roentgenol. 2011;197:386–92.CrossRefPubMedGoogle Scholar
  20. 20.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174:331–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Mortelé KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD, et al. Peripancreatic vascular abnormalities complicating acute pancreatitis complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol. 2004;52:67–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Leung TK, Lee CM, Lin SY, Chen HC, Wang HJ, Shen LK, et al. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol. 2005;11:6049–52.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gürleyik G, Emir S, Kiliçoglu G, Arman A, Saglam A. Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis. JOP. 2005;6:562–7.PubMedGoogle Scholar
  24. 24.
    Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatitis outcome. J Clin Gastroenterol. 2003;36:253–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Simchuk EJ, Traverso LW, Nukui Y, Kozarek RA. Computed tomography severity index is a predictor of outcomes for severe pancreatitis. Am J Surg. 2000;179:352–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Triantopoulou C, Lytras D, Maniatis P, Chrysovergis D, Manes K, Siafas I, et al. Computed tomography versus acute physiology and chronic health evaluation II score in predicting severity of acute pancreatitis. Pancreas. 2007;35:238–42.CrossRefPubMedGoogle Scholar
  27. 27.
    Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005;201:497–502.CrossRefPubMedGoogle Scholar
  28. 28.
    De Sanctis JT, Lee MJ, Gazelle GS, Boland GW, Halpern EF, Saini S, et al. Prognostic indicators in acute pancreatitis: CT vs. APACHE II. Clin Radiol. 1997;52:842–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Whitcomb DC. Clinical practice. Acute pancreatitis. N Eng J Med. 2006;354:2142–50.CrossRefGoogle Scholar
  30. 30.
    Forsmark CE, Baillie J, AGA Institute Clinical Practice and Economics Committee, AGA Institute Governing Board. AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132:2022–44.CrossRefPubMedGoogle Scholar
  31. 31.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.CrossRefPubMedGoogle Scholar
  32. 32.
    Banks PA, Freeman ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.CrossRefPubMedGoogle Scholar
  33. 33.
    Spanier BW, Nio Y, van der Hulst RW, Tuynman HA, Dijkgraaf MG, Bruno MJ. Practice and yield of early CT scan in acute pancreatitis: a Dutch observational multicenter study. Pancreatology. 2010;10:222–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Banday IR, Gattoo I, Khan AM, Javeed J, Gupta G, Latief M. Modified computed tomography severity index for evaluation of acute pancreatitis and its correlation with clinical outcome: a tertiary care hospital based observational study. J Clin Diagn Res. 2015;9:1–5.CrossRefGoogle Scholar
  35. 35.
    Gülen B, Sonmez E, Yaylaci S, Serinken M, Eken C, Dur A, et al. Effect of harmless acute pancreatitis score, red cell distribution width and neutrophil/lymphocyte ratio on the mortality of patients with nontraumatic acute pancreatitis at the emergency department. World J Emerg Med. 2015;6:29–33.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Lankisch PG, Weber-Dany B, Hebel K, Maisonneuve P, Lowenfels AB. The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol. 2009;7:702–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698–703.CrossRefPubMedGoogle Scholar
  38. 38.
    Tran DD, Cuesta MA. Evaluation of severity in patients with acute pancreatitis. Am J Gastroenterol. 1992;87:604–8.PubMedGoogle Scholar
  39. 39.
    Neoptolemos JP, Kemppainen EA, Mayer JM, Fitzpatrick JM, Raraty MG, Slavin J, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet. 2000;355:1955–60.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • A. Karagöz
    • 1
  • E. E. Ünlüer
    • 2
  • O. Oyar
    • 3
  • F. E. Topal
    • 2
  • F. Topal
    • 4
  1. 1.Department of Emergency Medicineİzmir Çiğli Training HospitalÇiğli/İzmirTurkey
  2. 2.Department of Emergency Medicineİzmir Katip Çelebi University Atatürk Research and Training HospitalKarabağlar/İzmirTurkey
  3. 3.Department of Radiology, Ataturk Research and Training Hospitalİzmir Katip Çelebi UniversityKarabağlar/İzmirTurkey
  4. 4.Department of Gastroenterology, Ataturk Research and Training Hospitalİzmir Katip Çelebi UniversityKarabağlar/İzmirTurkey

Personalised recommendations