Severity scoring for acute pancreatitis: where do we stand in 1999?

The last few years have seen a rapid evolution in the care of acute pancreatitis. Interventions such as endoscopic sphincterotomy with stone extraction and administration of platelet activating factor are effective but must be applied early. Ranson criteria and modified Glasgow score are widely used, but these systems often cannot separate mild versus severe pancreatitits within 24 hours of hospital admission. The Acute Physiology and Chronic Health Evaluation (APACHE II) is a good predictive system for severity of disease at admission. New single agent biologic markers hold some promise. The CT severity index is better than APACHE II for predicting local complications but not as good for predicting mortality and systemic morbidity. Modern care of acute pancreatitis requires the development of a rapid response team model, with early assessment by APACHE II, biologic markers, and, if indicated, the CT Severity Index.