Computed tomography scan imaging in diagnosing acute uncomplicated pancreatitis: Usefulness vs cost

Table 1 Ranson’s criteria at admission estimates severity and mortality of patients with acute pancreatitis based on initial lab values

Ranson criteria at admission
White blood cell count > 16000	1 point
Age > 55 years of age	1 point
Blood glucose > 200 mg/dL	1 point
Aspartate transaminase > 250	1 point
Lactate dehydrogease > 350	1 point

Scores ≤ 2 indicate mortality of 0-3%. Patients with scores of 2 or less were included in the study cohort.

Table 2 BISAP score predicts the mortality risk in acute pancreatitis based on the data within the first 24 h

BISAP score for pancreatitis mortality
Blood urea nitrogen > 25 mg/dL	1 point
Impaired mental status (disorientation, lethargy, somnolence, coma, stupor)	1 point
≥ 2 Systemic Inflammatory Response Syndrome (SIRS) Criteria (temperature > 38 °C or < 36 °C, heart rate > 90, respiratory rate > 20 or PaC02 < 32 mmHg, white blood cell count > 120000/mm3 or < 4000/mm3 or > 10% bands)	1 point
Age ≥ 60 years old	1 point
Pleural effusion present on imaging	1 point

Score of 0 has < 1% and scores ≤ 2 have 1.9% mortality risk, respectively. Patients with scores of 2 or less were included in the study cohort.

Table 3 Characteristics of patients admitted with acute uncomplicated pancreatitis (n = 405) n (%)

Characteristic	Number / %
mean age (range)	49.30 ± 17.42 yr (18-98 yr)
Gender
Male	201 (49.63)
Female	204 (50.37)
Etiology
Biliary/gallstone	149 (36.79)
Alcohol	142 (35.06)
Idiopathic	68 (16.79)
Drug-induced	17 (4.20)
Hypertriglyceridemia	4 (0.98)
Endoscopic retrograde cholangiopancreatography-related	1 (0.25)
Trauma	1 (0.25)
Autoimmune	1 (0.25)
Unknown	22 (5.43)

Table 4 Computed tomography imaging utilization, findings, and cost n (%)

Use of computed tomography imaging	Value
Underwent computed tomography imaging	210 (51.85)
Did not undergo computed tomography imaging	195 (48.15)
Type of computed tomography imaging (n = 210)
Computed Tomography abdomen/pelvis with contrast	122 (58.10)
Computed Tomography abdomen/pelvis without contrast	62 (29.52)
Computed Tomography abdomen/pelvis with and without contrast	9 (4.29)
Computed tomography abdomen with contrast	10 (4.76)
Computed tomography abdomen without contrast	1 (0.48)
Computed tomography abdomen with and without contrast	5 (2.38)
Computed tomography chest/abdomen/pelvis without contrast	1 (0.48)
Image findings
Normal imaging or uncomplicated acute pancreatitis	208 (99.05)
Acute pancreatitis with cyst formation	1 (0.48)
Acute pancreatitis with necrosis	1 (0.48)
Cost of computed tomography imaging
Average per computed tomography scan	$4450.38 ± $1185.98
Total cost	$947056