Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis

Thomas L. Bollen, Vikesh Singh, Rie Maurer, Kathryn Repas, Hendrik W. Van Es, Peter A. Banks, Koenraad J. Mortele

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of this study was to compare the modified CT severity index (MCTSI) with the CT severity index (CTSI) regarding assessment of severity parameters in acute pancreatitis (AP). Both CT indexes were also compared with the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) index. MATERIALS AND METHODS. Of 397 consecutive cases of AP, 196 (49%) patients underwent contrast-enhanced CT (n = 175) or MRI (n = 21) within 1 week of onset of symptoms. Two radiologists independently scored both CT indexes. Severity parameters included mortality, organ failure, pancreatic infection, admission to and length of ICU stay, length of hospital stay, need for intervention, and clinical severity of pancreatitis. Discrimination analysis and kappa statistics were performed. RESULTS. Although for both CT indexes a significant relationship was observed between the score and each severity parameter (p <0.0001), no significant differences were seen between the CT indexes. Compared with the APACHE II index, both CT indexes more accurately correlated with the need for intervention (CTSI, p = 0.006; MCTSI, p = 0.01) and pancreatic infection (CTSI, p = 0.04; MCTSI, p = 0.06) and more accurately diagnosed clinically severe disease (area under the curve, 0.87; 95% CI, 0.82-0.92). Interobserver agreement was excellent for both indexes: for CTSI, 0.85 (95% CI, 0.80-0.90) and for MCTSI, 0.90 (95% CI, 0.85-0.95). CONCLUSION. No significant differences were noted between the CTSI and the MCTSI in evaluating the severity of AP. Compared with APACHE II, both CT indexes more accurately diagnose clinically severe disease and better correlate with the need for intervention and pancreatic infection.

Original languageEnglish (US)
Pages (from-to)386-392
Number of pages7
JournalAmerican Journal of Roentgenology
Volume197
Issue number2
DOIs
StatePublished - Aug 2011

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APACHE
Pancreatitis
Length of Stay
Infection
Area Under Curve
Mortality

Keywords

  • Acute pancreatitis
  • CT severity index (CTSI)
  • Modified CTSI (MCTSI)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. / Bollen, Thomas L.; Singh, Vikesh; Maurer, Rie; Repas, Kathryn; Van Es, Hendrik W.; Banks, Peter A.; Mortele, Koenraad J.

In: American Journal of Roentgenology, Vol. 197, No. 2, 08.2011, p. 386-392.

Research output: Contribution to journalArticle

Bollen, Thomas L. ; Singh, Vikesh ; Maurer, Rie ; Repas, Kathryn ; Van Es, Hendrik W. ; Banks, Peter A. ; Mortele, Koenraad J. / Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. In: American Journal of Roentgenology. 2011 ; Vol. 197, No. 2. pp. 386-392.
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abstract = "OBJECTIVE. The purpose of this study was to compare the modified CT severity index (MCTSI) with the CT severity index (CTSI) regarding assessment of severity parameters in acute pancreatitis (AP). Both CT indexes were also compared with the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) index. MATERIALS AND METHODS. Of 397 consecutive cases of AP, 196 (49{\%}) patients underwent contrast-enhanced CT (n = 175) or MRI (n = 21) within 1 week of onset of symptoms. Two radiologists independently scored both CT indexes. Severity parameters included mortality, organ failure, pancreatic infection, admission to and length of ICU stay, length of hospital stay, need for intervention, and clinical severity of pancreatitis. Discrimination analysis and kappa statistics were performed. RESULTS. Although for both CT indexes a significant relationship was observed between the score and each severity parameter (p <0.0001), no significant differences were seen between the CT indexes. Compared with the APACHE II index, both CT indexes more accurately correlated with the need for intervention (CTSI, p = 0.006; MCTSI, p = 0.01) and pancreatic infection (CTSI, p = 0.04; MCTSI, p = 0.06) and more accurately diagnosed clinically severe disease (area under the curve, 0.87; 95{\%} CI, 0.82-0.92). Interobserver agreement was excellent for both indexes: for CTSI, 0.85 (95{\%} CI, 0.80-0.90) and for MCTSI, 0.90 (95{\%} CI, 0.85-0.95). CONCLUSION. No significant differences were noted between the CTSI and the MCTSI in evaluating the severity of AP. Compared with APACHE II, both CT indexes more accurately diagnose clinically severe disease and better correlate with the need for intervention and pancreatic infection.",
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AU - Van Es, Hendrik W.

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AU - Mortele, Koenraad J.

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