DefinePK

Research Objective

To compare the Glasgow scoring system and modified CTSI scoring system regarding their ability to predict the severe nature of acute pancreatitis according to the revised Atlanta classification in a tertiary care hospital in Pakistan.

Methodology

Comparative cross-sectional study conducted at the General Surgery Department, Combined Military Hospital, Rawalpindi from July 2020 to July 2021. Data was collected from 40 patients aged 30-70 years diagnosed with acute pancreatitis. Both Glasgow and modified CTSI scores were calculated for all cases. Diagnostic criteria for pancreatitis involved two out of three findings: epigastric pain, serum amylase/lipase levels at least three times the upper limit of normal, or characteristic imaging findings. Patients were categorized into mild, moderately severe, and severe acute pancreatitis based on the modified Atlanta (2012) classification. Statistical analysis was performed using SPSS version 28.0 and MS Excel 2013.

Methodology Flowchart

                        graph TD
    A["Patient Recruitment & Diagnosis of Acute Pancreatitis"] --> B["Data Collection"];
    B --> C["Calculate Glasgow Score"];
    B --> D["Calculate Modified CTSI Score"];
    C --> E["Categorize Severity based on Atlanta Classification"];
    D --> E;
    E --> F["Statistical Analysis"];
    F --> G["Compare Scoring Systems' Accuracy"];
    G --> H["Draw Conclusions"];                    

Discussion

The study concludes that the CTSI scoring system is superior to the Glasgow score in accurately detecting the severity of acute pancreatitis. While the Glasgow score is also effective, it was not as accurate as CTSI, particularly for severe cases where it did not yield a significant value (p>0.05). The increased incidence of acute pancreatitis globally is attributed to improved diagnostic tools. The study highlights the importance of CECT scans in improving the accuracy of severity prediction and overall grading of acute pancreatitis.

Key Findings

The CTSI scoring system demonstrated higher accuracy (0.994) than the Glasgow score (0.987) in predicting severe acute pancreatitis using the AUC graph. Both scoring systems showed significance (p<0.01) for mild and moderately severe acute pancreatitis. CTSI had a higher specificity (96.55%) compared to the Glasgow score (93.10%). The mean Glasgow score was 2.475 ± 2.975, and the mean CTSI score was 5.575 ± 2.458.

Conclusion

CTSI scoring is more accurate in detecting the severity of acute pancreatitis. While the Glasgow score is a close second, it is not as accurate an indicator as CTSI.

Fact Check

- The study included 40 patients.
- The mean Glasgow score was 2.475 ± 2.975.
- The mean CTSI score was 5.575 ± 2.458.

Mind Map