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Pancreatitis Severity Stratification

by Etienne Moore last modified 2011-09-13 11:19

Click here for details of Mr Moore's simple mnemonic 'PANCREAS' to help remember the criteria used to stratify the severity of acute pancreatitis attacks

When I was a junior trainee surgeon I invented a simple mnemonic to help me remember how to stratify acute pancreatitis patients. This proved particularly useful for consultant ward rounds and exams.  I decided to publish my mnemonic to help out other trainee doctors and also to gain some CV points!  I am particularly pleased that my PANCREAS mnemonic is now quoted in respected medical textbooks and taught at teaching hospitals and surgical colleges worldwide.  I hope that you find the mnemonic details below useful.

Ann R Coll Surg Engl 2000; 82: 16-17

A useful mnemonic for severity stratification in acute pancreatitis

Guidelines for the management of acute pancreatitis state that severity stratification should be made in all patients within 48 hours of admission to hospital. The fact that the criteria are difficult to remember often results in severity stratification being done poorly. A simple mnemonic makes this task easier for busy doctors on call, promoting better assessment and subsequent care of acute pancreatitis patients. It also enables a structured response to the favourite examination and ward round questions: 'What are Ranson's criteria?' and 'How do you assess the severity of an episode of pancreatitis?'

Acute pancreatitis is an unpredictable disease and it accounts for 3% of all cases of abdominal pain to hospital in Britain. The management of this condition has seen many recent changes but, despite these measures, the overall mortality has remained unaltered at around 10-15%. It is now well recognised that the initial prediction of the severity of an attack of acute pancreatitis into mild and severe has important implications for management, prognostication and use of health care resources. Failure to stratify early in an attack may result in potentially avoidable deaths.

Clinical examination assessment of pancreatitis alone is unreliable and will misclassify around 50% of patients. A variety of biochemical and objective criteria have been proposed which can increase the accuracy of differentiating between mild and severe attacks to above 80%. Acute pancreatitis patients should be assessed by blood C-reactive protein (CRP) and the modified Glasgow score. A peak level CRP measurement of > 210 mg/l in the first 4 days of the attack (or >120 mg/l at the end of the first week) indicates a severe attack.

The Glasgow score is a modification of the famous Ranson's criteria and was originally composed of nine factors. This has since been reduced to eight for reasons of improved predictive value and these can easily be remembered by the mnemonic 'PANCREAS'.  Three or more positive criteria constitute severe disease and the necessity for transfer to HDU or ITU. This simple method may lead to a reproducible improvement in patient management and success in answering certain frequently asked questions in medical and surgical exams and on ward rounds.

A useful mnemonic ('PANCREAS') for remembering thie modified Glasgow scoring system of severity prediction in acute pancreatitis:

Mnemonic letter Criteria Positive when:

 P

PaO2 

<60 mmHg 

  A 

Age 

>55 years 

 N

 Neutrophils (white blood cell count)

>15x109/l 

 C

 Calcium

<2 mmol/l 

 R

 Raised urea

>16 mmol/l 

 E

 Enzyme (lactate dehydrogenase (LDH))

>600 units/l 

 A

 Albumin

<32 g/l 

 S

 Sugar (glucose)

>10 mmol/l 

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