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Utility of the modified computed tomography severity index in prognostication of acute pancreatitis in children
Hiu Wah Chiu1, Kin Fen Kevin Fung2, Chi Lun Yvonne Leung1
1Department of Radiology, 2/F, Block B, Hong Kong Children's Hospital, 1 Shing Cheong Road, Kowloon Bay, Hong Kong.
Insights
The modified computed tomography severity index (mCTSI) effectively predicts severe outcomes in pediatric acute pancreatitis, outperforming C-reactive protein levels. This tool aids in assessing clinical outcomes and guiding patient management.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Critical Care Medicine
Background:
- Predicting severe pancreatitis in children is challenging.
- Limited data exists on prognostication system utility for pediatric acute pancreatitis.
Purpose of the Study:
- To evaluate the modified computed tomography severity index (mCTSI) for predicting clinical outcomes in pediatric acute pancreatitis.
- To compare mCTSI with CTSI and C-reactive protein (CRP) for prognostication.
Main Methods:
- Retrospective review of 47 pediatric patients with acute pancreatitis.
- Contrast-enhanced CT scans analyzed using mCTSI and CTSI.
- Comparison of mCTSI, CTSI, and CRP levels at 48 hours for predicting organ dysfunction.
Main Results:
- Higher median mCTSI scores were observed in patients who developed organ dysfunction (8 vs 4, P < 0.001).
- mCTSI ≥ 4 correlated with significantly longer pediatric intensive care unit (PICU) stays (3 vs 0 days, P < 0.001).
- mCTSI demonstrated superior prediction of organ dysfunction (AUC 0.891) compared to CRP (AUC 0.596).
Conclusions:
- Both mCTSI and CTSI are valuable tools for predicting clinical outcomes in pediatric acute pancreatitis.
- mCTSI is a better predictor of organ dysfunction than CRP levels.
- These indices can aid in risk stratification and management of pediatric acute pancreatitis.
Background:
The ability to predict severe pancreatitis in children remains a challenge, and limited evidence exists in the literature regarding the utility of different prognostication systems.
Objectives:
To assess the utility of the modified computed tomography severity index (mCTSI) in predicting clinical outcomes in paediatric patients with acute pancreatitis.
Materials/Methods:
A single-centre, retrospective review of all patients diagnosed with acute pancreatitis who underwent contrast-enhanced computed tomography of the abdomen and pelvis from January 2019 to December 2024. The performance in predicting the development of organ dysfunction of mCTSI, computed tomography severity index (CTSI), and C-reactive protein (CRP) level at 48 h of admission was compared.
Results:
We included 47 patients. Patients who developed organ dysfunction had a higher median mCTSI (8 [interquartile range, IQR 6-10]) compared to those who did not (4 [IQR 2-6], P < 0.001). In patients who had mCTSI ≥ 4, i.e. moderate and severe grades, the median length of PICU stay was significantly longer (mCTSI < 4 = 0 [IQR 0-0] days; mCTSI ≥ 4 = 3 [IQR 0-9] days, P < 0.001). Receiver operating characteristic analysis demonstrated mCTSI as a better predictor of organ dysfunction with an area under curve (AUC) of 0.891 (95% confidence interval [CI] 0.799-0.983), compared to CRP level which had an AUC of 0.596 (95% CI 0.433-0.759) (P = 0.002). No significant difference was identified between mCTSI and CTSI.
Conclusions:
Both mCTSI and CTSI were useful in predicting the clinical outcome of patients with acute pancreatitis and performed better than CRP level in predicting the development of organ dysfunction.
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