Dataset Information

Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis.

ABSTRACT: Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73-0.86) for CTSI; 0.87 (CI 0.83-0.90) for BISAP; 0.80 (CI 0.72-0.89) for mCTSI; 0.73 (CI 0.66-0.81) for CRP level; 0.87 (CI 0.81-0.92) for the Ranson score; and 0.91 (CI 0.88-0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76-0.85) for CTSI; 0.79, (CI 0.72-0.86) for BISAP; 0.83 (CI 0.75-0.91) for mCTSI; 0.73 (CI 0.64-0.83) for CRP level; 0.81 (CI 0.75-0.87) for Ranson score and 0.80 (CI 0.77-0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

SUBMITTER: Miko A

PROVIDER: S-EPMC6718714 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis.

Mikó Alexandra A Vigh Éva É Mátrai Péter P Soós Alexandra A Garami András A Balaskó Márta M Czakó László L Mosdósi Bernadett B Sarlós Patrícia P Erőss Bálint B Tenk Judit J Rostás Ildikó I Hegyi Péter P

Frontiers in physiology 20190827

Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Em ...[more]

PMID: 31507427

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Project description:BackgroundLiterature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis (AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography (CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis (AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of AUP.AimTo assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for AUP.MethodsIn this Institutional Review Board-approved retrospective, single-center study, we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases (ICD-9) code for AP (577.0) and ICD-10 codes for different etiological AP (K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria (presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal). Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest AUP. The utilization and cost of imaging in these patients were recorded.ResultsBetween January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients (31%) met our inclusion criteria for AUP (201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients (51.85%) underwent CT imaging. One patient (0.47%) had evidence of pancreatic necrosis, one patient had cyst formation (0.47%), and the remaining 208 patients (99.05%) had either normal CT scan imaging or findings consistent with mild AP without necrosis. The average cost of CT scan imaging was $4510 with a total cost of $947056. Median length of hospitalization stay was 3 d among both groups. Combining Ranson's Criteria and BISAP score identified AUP in our patient population with an accuracy of 99.5%.ConclusionCT imaging is unnecessary when AUP is diagnosed clinically and biochemically. Reducing overuse of diagnostic CT scans will decrease healthcare expenditure and radiation exposure to patients.

Project description:BackgroundObjective assessment of metal artifact strength and the effectiveness of metal artifact reduction algorithms in computed tomography requires a quantitative metric. Metrics described in the literature are typically employed to compare the artifact strength in images reconstructed from the same raw data, but their robustness against varying scan conditions and repeated scans over time as it occurs in periodic quality assurance has not been investigated.PurposeA new robust metric for quantifying metal artifacts in computed-tomography images is proposed and compared to other commonly used metrics.MethodsThe proposed artifact metric is based on the location parameter of the Gumbel distribution, described previously in the literature, but normalized to the location parameter in a background region-of-interest to obtain a noise-independent artifact metric. The metric was compared to three other quantitative metal artifact metrics (artifact-index, contrast-to-noise ratio, Gumbel-evaluation method) by evaluating metals artifacts in phantom scans and in clinical images. Robustness of the artifact metrics was evaluated using repeated scans with varying noise and against small variations in the selected regions-of-interest.ResultsThe proposed artifact metric was independent of the underlying image noise and could be reproduced more consistently under slight changes of the region-of-interest within the artifact than the other investigated methods. The coefficient-of-variation was 5.7% on average with varying regions-of-interest in phantom scans and 2.5% in patient scans compared to 9.2% in phantoms scans and 9.9% in patient scans for the next-best performing noise-independent metric. Setup reproducibility was better than 5% and was comparable to the other metrics. The new metric correlated linearly with the artifact strength. The contrast-to-noise ratio, although often used in artifact quantification, was found to be an inadequate metric due to its lack of robustness against minute changes in the position, size, and pixel values of the region-of-interest chosen for calculating the metric and because it showed no correlation with the artifact strength.ConclusionsA new metal artifact metric has been proposed that is robust under changing scan conditions and less sensitive to user-dependent choices of the region-of-interest than other metrics. The new metric is straightforward to calculate and simple to implement in software commonly used for evaluation of medical imaging systems.

Dataset Information

Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis.

Publications

Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis.

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