Pediatric Radiology

, Volume 48, Issue 7, pp 954–961 | Cite as

Utility of CT classifications to predict unfavorable outcomes in children with acute pancreatitis

  • Yojhan E. Izquierdo
  • Eileen V. Fonseca
  • Luz-Ángela Moreno
  • Rubén D. Montoya
  • Rafael Guerrero Lozano
Original Article



Computed tomography (CT) is useful for the diagnosis of local complications in children with acute pancreatitis but its role as a prognostic tool remains controversial.


To establish the correlation between the CT Severity Index and the Revised Atlanta Classification regarding unfavorable outcomes such as severe acute pancreatitis and need for Pediatric Special Care Unit attention in children with acute pancreatitis.

Materials and methods

We conducted a retrospective and concordance cohort study in which we obtained abdominal CT scans from 30 patients ages 0 to 18 years with acute pancreatitis. Two pediatric radiologists interpreted the results using the CT Severity Index and the Revised Atlanta Classification. The kappa coefficient was determined for each scale. The association among severe acute pancreatitis, need for admission to the Pediatric Special Care Unit and CT systems were established using chi-square or Mann-Whitney U tests. The best CT Severity Index value to predict the need for admission to the Pediatric Special Care Unit was estimated through a receiver operating characteristic (ROC) curve.


Mean CT Severity Index was 5.1±2.8 (mean ± standard deviation on a scale of 0 to 10) for the severe acute pancreatitis group vs. 3.8±2.7 for the mild acute pancreatitis group (P=0.230). The CT Severity Index for the children who were not hospitalized at the Pediatric Special Care Unit was 2.2±2.2 vs. 5.6±2.4 for the group hospitalized at the Pediatric Special Care Unit (P=0.001). Only parenchymal necrosis >30% was associated with severe acute pancreatitis (P=0.021). A CT Severity Index ≥3 has a sensitivity of 89% and specificity of 72% to predict need for admission to the Pediatric Special Care Unit. None of the Revised Atlanta Classification categories was associated with severe acute pancreatitis or admission to the Pediatric Special Care Unit.


A CT Severity Index ≥3 in children with acute pancreatitis who require CT assessment based on clinical criteria is associated with the need for admission to the Pediatric Special Care Unit. We found that pancreatic necrosis greater than 30% is the only tomographic parameter related to severe acute pancreatitis. New studies with a greater sample size are necessary to confirm this result.


Children Computed tomography Intensive care unit Pancreas Pancreatitis Severity of illness index 



This study was funded by Universidad Nacional de Colombia through the national call for projects to strengthen research, creation and innovation at Universidad Nacional de Colombia 2016–2018.

Compliance with ethical standards

Conflicts of interest

Eileen Viviana Fonseca obtained financial support from Universidad Nacional de Colombia for attending to 21st Congreso Latinoamericano and 12th Congreso Iberoamericano de Gastroenterología, Hepatología y Nutrición Pediátrica, and the 30th Reunión de la Sociedad Portuguesa de Gastroenterología, Hepatología y Nutrición Pediátrica in Oporto, Portugal, to present the study results as a poster.


  1. 1.
    Morinville VD, Husain SZ, Bai H et al (2012) Definitions of pediatric pancreatitis and survey of current clinical practices: report from INSPPIRE (International Study Group of Pediatric Pancreatitis: in Search for a Cure). J Pediatr Gastroenterol Nutr 55:261–265CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Antunes H, Nascimento J, Mesquita A et al (2014) Acute pancreatitis in children: a tertiary hospital report. Scand J Gastroenterol 49:642–647CrossRefPubMedGoogle Scholar
  3. 3.
    Lautz TB, Chin AC, Radhakrishnan J (2011) Acute pancreatitis in children: spectrum of disease and predictors of severity. J Pediatr Surg 46:1144–1149CrossRefPubMedGoogle Scholar
  4. 4.
    Birgisson H, Moller PH, Birgisson S et al (2002) Acute pancreatitis: a prospective study of its incidence, aetiology, severity, and mortality in Iceland. Eur J Surg 168:278–282CrossRefPubMedGoogle Scholar
  5. 5.
    Suzuki M, Fujii T, Takahiro K et al (2008) Scoring system for the severity of acute pancreatitis in children. Pancreas 37:222–223CrossRefPubMedGoogle Scholar
  6. 6.
    DeBanto JR, Goday PS, Pedroso MRA et al (2002) Acute pancreatitis in children. Am J Gastroenterol 97:1726–1731CrossRefPubMedGoogle Scholar
  7. 7.
    Lopez MJ (2002) The changing incidence of acute pancreatitis in children: a single-institution perspective. J Pediatr 140:622–624CrossRefPubMedGoogle Scholar
  8. 8.
    Lautz TB, Turkel G, Radhakrishnan J et al (2012) Utility of the computed tomography severity index (Balthazar score) in children with acute pancreatitis. J Pediatr Surg 47:1185–1190CrossRefPubMedGoogle Scholar
  9. 9.
    Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:603–613CrossRefPubMedGoogle Scholar
  10. 10.
    Banks PA, Bollen TL, Dervenis C et al (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111Google Scholar
  11. 11.
    World Medical Association (2013) Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–2194CrossRefGoogle Scholar
  12. 12.
    Bradley E 3rd (1993) A clinically based classification system for acute pancreatitis. Arch Surg 128:586–590CrossRefPubMedGoogle Scholar
  13. 13.
    Thoeni RF (2012) The Revised Atlanta Classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 262:751–764CrossRefPubMedGoogle Scholar
  14. 14.
    Larvin M, Chalmers AG, McMahon MJ (1990) Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis. BMJ 300:1425–1428CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Siegel M, Matin K, Worthington J (1987) Normal and abnormal pancreas in children: US studies. Radiology 165:15–18CrossRefPubMedGoogle Scholar
  16. 16.
    Sim J, Wright CC (2005) The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther 85:257–268PubMedGoogle Scholar
  17. 17.
    Abu-El-Haija M, Lin TK, Palermo J (2014) Update to the management of pediatric acute pancreatitis: highlighting areas in need of research. J Pediatr Gastroenterol Nutr 58:689–693PubMedGoogle Scholar
  18. 18.
    Mortele KJ, Shankar S, Zou KH et al (2004) A modified CT severity index for evaluating acute pancreatitis. AJR Am J Roentgenol 183:1261–1265CrossRefPubMedGoogle Scholar
  19. 19.
    Bollen TL, Singh VK, Repas K et al (2011) Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. AJR Am J Roentgenol 197:386–392CrossRefPubMedGoogle Scholar
  20. 20.
    Schmid S, Uhl W, Friess H et al (1999) The role of infection in acute pancreatitis. Gut 45:311–316CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Perez A, Whang EE, Brooks DC et al (2002) Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas 25:229–233CrossRefPubMedGoogle Scholar
  22. 22.
    Meyrignac O, Bournet B, Mokrane FZ (2015) Acute pancreatitis: extrapancreatic necrosis volume as early predictor of severity. Radiology 276:119–128CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yojhan E. Izquierdo
    • 1
  • Eileen V. Fonseca
    • 2
  • Luz-Ángela Moreno
    • 1
    • 3
  • Rubén D. Montoya
    • 1
    • 3
  • Rafael Guerrero Lozano
    • 4
  1. 1.Department of Radiology and Diagnostic ImagingUniversidad Nacional de ColombiaBogotá, D.C.Colombia
  2. 2.Department of PediatricsUniversidad Nacional de ColombiaBogotá, D.C.Colombia
  3. 3.Department of Radiology and Diagnostic ImagingFundación Hospital de la MisericordiaBogotá, D.C.Colombia
  4. 4.Division of Pediatric Gastroenterology, Department of PediatricsUniversidad Nacional de ColombiaBogotá, D.C.Colombia

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