Acute pancreatitis; evaluation of modified glasgow scoring system [IMRIE]

ABSTRACT

To determine whether in our setup the Modified Glasgow Scoring System is still an accurate marker for the assessment of severity in acute pancreatitis. Observational study. Surgical Unit, CMH Peshawar. January 2005 to January 2008. It is an observational study of 50 male and female patients between ages of 1 5-75 years [Mean 43.3]. Male to female ratio was 11.3. They were graded mild, moderate and severe using the 8 variables / markers of Modified Glasgow Scoring System. Exclusion from this study were the patients with acute pancreatitis who were treated at the same institution but not admitted to the surgical ICU, those admitted after inter institutional transfer for tertiary care and patients admitted as sick transfer from other hospitals after 24 hours. On the basis of variables in the Modified Glasgow scoring system [Imrie], 18 patients were predicted with the severe outcome, but only 15 [83%] cases had an actual severe outcome. Whereas 3 cases [17%] did not follow the prediction and behaved as moderate pancreatitis. Similarly, 16 cases predicted as moderate pancreatitis, 14 [88%] followed the prediction and only 2 [12%] cases behaved as mild cases.16 cases were predicted mild, but 13 [81%] followed the prediction and only 3 [19%] switched to moderately severe group. Thus the overall accuracy of Modified Glasgow Scoring System was found in 42 [84%] cases. Bililary pathology remained the main aetiological factor. Two of the variables were significantly deranged in severe cases. These were age over 50 [4 cases], and WBC count > 20x 10[9]/l [12 cases]. Hospital stay varied between 4-21 days [Mean 9 days]. Conclusion: The Modified Glasgow Scoring System remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple, easy to apply with good predictive value and can be used in all hospital settings