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Acute pancreatitis in children
John R DeBanto1, Praveen S Goday, Martha R A Pedroso
1Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, USA.
Insights
A new scoring system for pediatric acute pancreatitis demonstrates improved sensitivity and negative predictive value compared to existing methods. This tool aids in better prediction of severe outcomes in children with this condition.
Area of Science:
- Pediatric Gastroenterology
- Clinical Scoring Systems
- Acute Pancreatitis Research
Background:
- Existing scoring systems for acute pancreatitis lack validation in pediatric populations.
- Accurate severity prediction is crucial for timely and appropriate management of pediatric acute pancreatitis.
Purpose of the Study:
- To evaluate existing scoring systems (Ranson, Glasgow) for pediatric acute pancreatitis.
- To develop and validate a novel scoring system tailored for children.
- To investigate the common etiologies of acute pancreatitis in pediatric patients.
Main Methods:
- A multi-center chart review of 301 pediatric acute pancreatitis admissions.
- Calculation of Ranson and Glasgow scores for all cases.
- Identification and incorporation of key clinical parameters into a new scoring system, validated across centers.
Main Results:
- Eight parameters identified for the new pediatric scoring system: age, weight, WBC, LDH, Ca2+, albumin, fluid sequestration, and BUN rise.
- The new system achieved 70% sensitivity and 91% negative predictive value for severe outcomes (cutoff at 3 criteria).
- Compared to Ranson and Glasgow scores, the new system showed superior sensitivity (70% vs. 30%/35%) and negative predictive value (91% vs. 85%/85%).
Conclusions:
- The newly developed scoring system demonstrates superior performance in predicting severity of acute pancreatitis in children.
- This pediatric-specific tool offers improved sensitivity and negative predictive value over existing general scoring systems.
- Further research may refine the system and explore its utility in diverse pediatric populations.
Objectives:
Currently, there is no scoring system for predicting severity in acute pancreatitis in children. Our intent was to evaluate the performance of existing scoring systems in children, to develop a system for children, and to examine the etiology of acute pancreatitis in children.
Methods:
A chart review of children with acute pancreatitis was conducted at six centers, three serving as criterion centers and three as validation centers. Ranson and Glasgow scores were calculated for each admission. Additional clinical data were collected, and parameters correlating with severity were incorporated into a new scoring system. Performance characteristics were calculated for each system.
Results:
A total of 301 admissions were reviewed, 202 in the criterion group and 99 in the validation group. Eight parameters were included in a new scoring system for children. The parameters were as follows: age (<7 yr), weight (<23 kg), admission WBC (>18,500), admission LDH (>2,000), 48-h trough Ca2+ (<8.3 mg/dl), 48-h trough albumin (<2.6 g/dl), 48-h fluid sequestration (>75 ml/ kg/48 h), and 48-h rise in BUN (>5 mg/dl). When the cut-off for predicting a severe outcome was set at 3 criteria, the new system had better sensitivity versus Ranson and Glasgow scores (70% vs 30% and 35%, respectively) and a better negative predictive value (91% vs 85% and 85%). The specificity (79% vs 94% and 94%) and positive predictive value (45% vs 57% and 61%) fell slightly.
Conclusion:
The new scoring system performs better in this group than do existing systems.
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