Modified Marshall Score: An Underutilised Prognostication Tool for Acute Pancreatitis

Area of Science:

• Gastroenterology and Hepatology
• Surgical Critical Care

Background:

• Acute pancreatitis (AP) is a significant cause of mortality, with organ failure complicating 20% of cases.
• Early risk stratification is crucial for managing AP and preventing systemic injury.
• The Modified Marshall (MM) score is a standard tool for assessing organ dysfunction in AP.

Purpose of the Study:

• To evaluate the utilization of the MM score in acute pancreatitis patients.
• To identify reasons for its underutilization in clinical practice.
• To assess the MM score's effectiveness in risk stratification and predicting patient outcomes.

Main Methods:

• Retrospective review of 127 AP patients over two years.
• Analysis of electronic records, discharge letters, and handover sheets.
• Questionnaire survey of clinicians regarding MM score underutilization.
• Retrospective risk stratification using MM score, Glasgow-Imrie score, and CT severity index.

Main Results:

• Only 18.9% of patients had an MM score documented.
• Key underutilization reasons included unfamiliarity, complexity, and workload.
• A simplified MM score and guidance improved utilization (7/10 patients).
• Low MM scores (<2) accurately predicted no need for ITU or surgery (95.8% of patients).

Conclusions:

• The Modified Marshall score is underutilized in current clinical practice.
• Despite underutilization, the MM score is a reliable tool for risk stratification.
• The MM score has a high negative predictive value, aiding trainees in identifying patients not requiring intensive care.