title: Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis.
abstract: BACKGROUND
  Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear.
  
  
  METHODS
  The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups: the early CT group (CT done at 4-5 days after the onset of pain) and the late CT group (CT done in days 6-14 following onset of pain). The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT, such as detection of pancreatic necrosis and local complications, and CT severity index.
  
  
  RESULTS
  Of 214 patients [143 (66.8%) males; mean age 39.87 ± 13.52 years], 21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP. The early CT group included 114 patients, whilst the late CT group had 79. The mean CT severity index was higher in the late CT group (6.65 ± 2.27 vs. 5.52 ± 2.7; P = 0.005). The incidence of persistent organ failure in the early group was no different from that of the late group (38.6% vs. 49.4%; P = 0.143). Local complications were detected more often in the late CT group (84.8% vs. 68.4%; P = 0.011). There was no difference between the two groups in the need for percutaneous drainage, surgery, or mortality (all P > 0.05).
  
  
  CONCLUSIONS
  Although performing early CT does not adversely affect the outcome in AP, CT carried out more than 5 days after the onset of symptoms may detect more local complications.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India drsurinderrana@yahoo.co.in.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Bhasin
keywords: acute pancreatitis; clinical outcomes; complications; computed tomography