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Utility of CT classifications to predict unfavorable outcomes in children with acute pancreatitis

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Abstract

Background

Computed tomography (CT) is useful for the diagnosis of local complications in children with acute pancreatitis but its role as a prognostic tool remains controversial.

Objective

To establish the correlation between the CT Severity Index and the Revised Atlanta Classification regarding unfavorable outcomes such as severe acute pancreatitis and need for Pediatric Special Care Unit attention in children with acute pancreatitis.

Materials and methods

We conducted a retrospective and concordance cohort study in which we obtained abdominal CT scans from 30 patients ages 0 to 18 years with acute pancreatitis. Two pediatric radiologists interpreted the results using the CT Severity Index and the Revised Atlanta Classification. The kappa coefficient was determined for each scale. The association among severe acute pancreatitis, need for admission to the Pediatric Special Care Unit and CT systems were established using chi-square or Mann-Whitney U tests. The best CT Severity Index value to predict the need for admission to the Pediatric Special Care Unit was estimated through a receiver operating characteristic (ROC) curve.

Results

Mean CT Severity Index was 5.1±2.8 (mean ± standard deviation on a scale of 0 to 10) for the severe acute pancreatitis group vs. 3.8±2.7 for the mild acute pancreatitis group (P=0.230). The CT Severity Index for the children who were not hospitalized at the Pediatric Special Care Unit was 2.2±2.2 vs. 5.6±2.4 for the group hospitalized at the Pediatric Special Care Unit (P=0.001). Only parenchymal necrosis >30% was associated with severe acute pancreatitis (P=0.021). A CT Severity Index ≥3 has a sensitivity of 89% and specificity of 72% to predict need for admission to the Pediatric Special Care Unit. None of the Revised Atlanta Classification categories was associated with severe acute pancreatitis or admission to the Pediatric Special Care Unit.

Conclusion

A CT Severity Index ≥3 in children with acute pancreatitis who require CT assessment based on clinical criteria is associated with the need for admission to the Pediatric Special Care Unit. We found that pancreatic necrosis greater than 30% is the only tomographic parameter related to severe acute pancreatitis. New studies with a greater sample size are necessary to confirm this result.

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Acknowledgments

This study was funded by Universidad Nacional de Colombia through the national call for projects to strengthen research, creation and innovation at Universidad Nacional de Colombia 2016–2018.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, Universidad Nacional de Colombia, Carrera 30 #45-03, Building 271, Office 102, 111321, Bogotá, D.C., Colombia

    Yojhan E. Izquierdo, Luz-Ángela Moreno & Rubén D. Montoya

  2. Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, D.C., Colombia

    Eileen V. Fonseca

  3. Department of Radiology and Diagnostic Imaging, Fundación Hospital de la Misericordia, Bogotá, D.C., Colombia

    Luz-Ángela Moreno & Rubén D. Montoya

  4. Division of Pediatric Gastroenterology, Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, D.C., Colombia

    Rafael Guerrero Lozano

Authors
  1. Yojhan E. Izquierdo
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  2. Eileen V. Fonseca
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  3. Luz-Ángela Moreno
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  4. Rubén D. Montoya
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  5. Rafael Guerrero Lozano
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Corresponding author

Correspondence to Yojhan E. Izquierdo.

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Conflicts of interest

Eileen Viviana Fonseca obtained financial support from Universidad Nacional de Colombia for attending to 21st Congreso Latinoamericano and 12th Congreso Iberoamericano de Gastroenterología, Hepatología y Nutrición Pediátrica, and the 30th Reunión de la Sociedad Portuguesa de Gastroenterología, Hepatología y Nutrición Pediátrica in Oporto, Portugal, to present the study results as a poster.

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Izquierdo, Y.E., Fonseca, E.V., Moreno, LÁ. et al. Utility of CT classifications to predict unfavorable outcomes in children with acute pancreatitis. Pediatr Radiol 48, 954–961 (2018). https://doi.org/10.1007/s00247-018-4101-4

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  • DOI: https://doi.org/10.1007/s00247-018-4101-4

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