A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome.
OBJECTIVE
This study was conducted to assess the correlation with patient outcome and interobserver variability of a modified CT severity index in the evaluation of patients with acute pancreatitis compared with the currently accepted CT severity index.


METHODS
Of 266 consecutive patients diagnosed with acute pancreatitis during a 1-year period, 66 underwent contrast-enhanced MDCT within 1 week of the onset of symptoms. Three radiologists who were blinded to patient outcome independently scored the severity of the pancreatitis using both the currently accepted and modified CT severity indexes. The modified index included a simplified assessment of pancreatic inflammation and necrosis as well as an assessment of extrapancreatic complications. Outcome parameters included the length of hospital stay; the need for surgery or percutaneous intervention; and the occurrences of infection, organ failure, and death. For both the current and modified indexes, correlation between the severity of the pancreatitis and patient outcome was estimated using the Wilcoxon's rank sum test and Fisher's exact test. Interobserver agreement for both indexes was calculated using the kappa statistic.


RESULTS
When applying the modified index, the severity of pancreatitis and the following parameters correlated more closely than when the currently accepted index was applied: the length of the hospital stay (0-34 days) (modified index [p = 0.0054-0.0714] vs current index [p = 0.0052-0.3008]); the need for surgical or percutaneous procedures (10/66 patients) (modified index [p = 0.0112] vs current index [p = 0.0324]); and the occurrence of infection (21/66 patients) (modified index [p < 1e(-10)] vs current index [p < 1e(-04)]). Significant correlation between the severity of pancreatitis and the development of organ failure (9/66 patients) was seen only using the modified index (p = 0.0024), not the current index (p = 0.0513). The interobserver agreement was similar with the modified (kappa range, 0.71-0.85) and the current (kappa range, 0.63-0.86) indexes.


CONCLUSIONS
The modified CT severity index correlates more closely with patient outcome measures than the currently accepted CT severity index, with similar interobserver variability.
Mortele
Koenraad J
KJ
Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115. kmortele@partners.org
Wiesner
Walter
W
Intriere
Lisa
L
Shankar
Shridhar
S
Zou
Kelly H
KH
Kalantari
Babek N
BN
Perez
Alex
A
vanSonnenberg
Eric
E
Ros
Pablo R
PR
Banks
Peter A
PA
Silverman
Stuart G
SG
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010179:Pancreas / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media