Utility of the modified computed tomography severity index in prognostication of acute pancreatitis in children.

BACKGROUND

The ability to predict severe pancreatitis in children remains a challenge, and limited evidence exists in the literature regarding the utility of different prognostication systems.

OBJECTIVES

To assess the utility of the modified computed tomography severity index (mCTSI) in predicting clinical outcomes in paediatric patients with acute pancreatitis.

MATERIALS/METHODS: A single-centre, retrospective review of all patients diagnosed with acute pancreatitis who underwent contrast-enhanced computed tomography of the abdomen and pelvis from January 2019 to December 2024. The performance in predicting the development of organ dysfunction of mCTSI, computed tomography severity index (CTSI), and C-reactive protein (CRP) level at 48 h of admission was compared.

RESULTS

We included 47 patients. Patients who developed organ dysfunction had a higher median mCTSI (8 [interquartile range, IQR 6-10]) compared to those who did not (4 [IQR 2-6], P < 0.001). In patients who had mCTSI ≥ 4, i.e. moderate and severe grades, the median length of PICU stay was significantly longer (mCTSI < 4 = 0 [IQR 0-0] days; mCTSI ≥ 4 = 3 [IQR 0-9] days, P < 0.001). Receiver operating characteristic analysis demonstrated mCTSI as a better predictor of organ dysfunction with an area under curve (AUC) of 0.891 (95% confidence interval [CI] 0.799-0.983), compared to CRP level which had an AUC of 0.596 (95% CI 0.433-0.759) (P = 0.002). No significant difference was identified between mCTSI and CTSI.

CONCLUSIONS

Both mCTSI and CTSI were useful in predicting the clinical outcome of patients with acute pancreatitis and performed better than CRP level in predicting the development of organ dysfunction.