Describing computed tomography findings in acute necrotizing pancreatitis with the Atlanta classification: an interobserver agreement study.
OBJECTIVE
The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. A study was undertaken to assess the interobserver agreement of categorizing peripancreatic collections on computed tomography (CT) using the Atlanta classification.


METHODS
Preoperative contrast-enhanced CTs from 70 consecutive patients (49 men; median age, 59 years; range, 29-79 years) operated for acute necrotizing pancreatitis (2000-2003) in 11 hospitals were reviewed. Five abdominal radiologists independently categorized the peripancreatic collections according to the Atlanta classification. Radiologists were aware of the timing of the CT and the clinical condition of the patient. Interobserver agreement was determined.


RESULTS
Interobserver agreement among the radiologists was poor (kappa, 0.144; SD, 0.095). In 3 (4%) of 70 cases, the same Atlanta definition was chosen. In 13 (19%) of 70 cases, 4 radiologists agreed, and in 42 (60%) of 70 cases, 3 radiologists agreed on the definition. In 21 cases (30%), 1 or more of the radiologists classified a collection as "pancreatic abscess," whereas 1 or more radiologist used another Atlanta definition.


CONCLUSIONS
The interobserver agreement of the Atlanta classification for categorizing peripancreatic collections in acute pancreatitis on CT is poor. The Atlanta classification should not be used to describe complications of acute pancreatitis on CT.
Besselink
Marc G H
MG
Department of Surgery, University Medical Center Utrecht, The Netherlands. m.besselink@umcutrecht.nl
van Santvoort
Hjalmar C
HC
Bollen
Thomas L
TL
van Leeuwen
Maarten S
MS
Laméris
Jan S
JS
van der Jagt
Eric J
EJ
Strijk
Simon P
SP
Buskens
Erik
E
Freeny
Patrick C
PC
Gooszen
Hein G
HG
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015588:Observer Variation; D010179:Pancreas / Q000000981:diagnostic imaging*; D019283:Pancreatitis, Acute Necrotizing / Q000145:classification / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D009626:Terminology as Topic; D014057:Tomography, X-Ray Computed