Utility of the computed tomography severity index (Balthazar score) in children with acute pancreatitis.
BACKGROUND
Previous studies in children with acute pancreatitis have demonstrated that clinical scoring systems such as the Ranson, modified Glasgow, and pediatric acute pancreatitis scores are of value in predicting severity of the disease. The aim of this study was to determine the predictive value of the computed tomography severity index (CTSI or Balthazar score) in pediatric patients.


METHODS
All children (≤ 18 years) admitted to our institution with acute pancreatitis from 2000 through 2009 were reviewed. Contrast-enhanced computed tomographic (CT) images at presentation were retrospectively reviewed by 2 pediatric radiologists. Peripancreatic fluid and the extent of necrosis were assessed to determine the CTSI. The predictive value of the CTSI was calculated and compared with clinical scoring systems.


RESULTS
Of 211 children with acute pancreatitis, 64 underwent contrast-enhanced CT at presentation. The median age was 12.3 years. Etiology of pancreatitis was idiopathic (35.9%), gallstone (17.2%), medication-induced (20.3%), posttransplant (9.4%), traumatic (6.3%), structural (1.6%), and other (9.4%). The sensitivity, specificity, positive predictive value, and negative predictive value of the CTSI (using a cutoff score of 4+) were 81%, 76%, 62%, and 90%, respectively, which compared favorably to the results of the pediatric acute pancreatitis (53%, 72%, 41%, 80%), Ranson (71%, 87%, 67%, 89%), and modified Glasgow (71%, 87%, 67%, 89%) scores.


CONCLUSIONS
The CTSI is superior to clinical scoring systems for identifying children with acute pancreatitis at heightened risk for developing serious complications.
Department of Surgery, Children's Memorial Hospital, Northwestern University, Chicago, IL 60614, USA.
Timothy B
TB
Lautz
Gary
G
Turkel
Jayant
J
Radhakrishnan
Mary
M
Wyers
Anthony C
AC
Chin
D000208:Acute Disease; D000293:Adolescent; D000681:Amylases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002764:Cholecystitis / Q000150:complications; D003287:Contrast Media; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood; D010179:Pancreas / Q000293:injuries; D010195:Pancreatitis / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D008049:Lipase; D000681:Amylases