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Three Part Question

In [patients with acute pancreatitis], is [Ranson's criteria or Glasgow criteria] best in [predicting the need for intensive care admission]?

Clinical Scenario

A 48 year old woman presented to the accident and emergency department with severe epigastric pain radiating to the back. Acute pancreatitis was diagnosed. You wonder if Ranson's criteria or Glasgow criteria is better in predicting the need for referring her to the intensive care unit.

Search Strategy

Medline and EMBASE and CINAHL 1966 to June Week 4 2006 using Ovid Interface.
([pancreatitis.mp. or exp Pancreatitis, Acute Necrotizing/ or exp Pancreatitis/ or exp Pancreatitis, Alcoholic/] AND [exp "Severity of Illness Index"/ or ranson.mp.] AND [(glasgow adj3 criteria).mp. [mp=title, original title, abstract, name of substance word, subject heading word] OR [modified imrie.mp. or exp "Severity of Illness Index"/]] limit to human, English language and all adult(19 plus))

Search Outcome

373 papers were found in total, of which 3 were relevant. They are shown in the table below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Williams, M. Simms, H H 1999 USA	273 patients' charts with discharge code 'pancreatitis' were reviewed between 1992 and 1996.	Prognostic study	Length of hospital stay	Ranson: correlation=0.68, p=0.03	Full article awaiting
				Modified Glasgow: correlation=0.78, p=0.007
				Conclusion: Modified Glasgow has a slightly larger correlation with the length of hospital stay

Comment(s)

Ranson's criteria and Modified Glasgow scale are both useful prognostic tools for acute pancreatitis. Out of the 3 papers found, 2 were review articles, only one was a prognostic study. More studies comparing Ranson's criteria and Glasgow Scale are needed to be done in order to give reliable answer to this question.

Clinical Bottom Line

The Modified Glasgow scale has a slightly stronger association with predicting the length of hospital stay from the above study.

References

1. Steinberg WM Predictors of severity of acute pancreatitis. Gasteroenterology clinics of North America 19(4):849-61, 1990, DEC
2. Williams, M. Simms, HH Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis. Critical Care Medicine. 27(5):901-7, 1999 May
3. Imrie, Clement W Prognostic indicators in acute pancreatitis. Canadian Journal of Gastroenterology. 17(5):325-8, 2003 May