Comparison of Revised Atlanta Classification and BISAP Clinical Score in Assessing Acute Pancreatitis Severity with Computed Tomography Imaging Findings: A Prospective study

Background:Contrast-enhanced computed tomography (CT) is considered as the investigation of choice in established cases of acute pancreatitis in the assessment of pancreatic necrosis and has become an integral part of the new classification system. Revised Atlanta Classification (RAC) is a standardized classification system that uses easily available CT for imaging and facilitates more precise communication between the radiologists and clinicians and allows better treatment planning. BISAP (Bedside Index for Severity in Acute Pancreatitis) clinical scoring is a simple easy to use system which helps in early prediction of risk of mortality in the patients of acute pancreatitis. The aim of our study was to find the correlation between these two excellent radiological and clinical tools so as to triage, predict, treat the patients of acute pancreatitis with better accuracy. Material and Method: This was a single-center prospective observational study, conducted over a period of 18 months on 208 adult patients, diagnosed as a case of acute pancreatitis by clinical and laboratory parameters. This study was conducted using a TOSHIBA 16 slice CT scanner. Pre and post contrast scans were acquired through portal venous phase approximately 80 seconds after contrast injection. Imaging findings were classified according to Revised Atlanta classification and correlated with clinical BISAP scoring system and results were interpreted using SPSS software version 21. Results: Interstitial edematous pancreas with acute peripancreatic fluid collection was more common than necrotizing pancreatitis in our study population. Out of the total 208, only 47 (23%) had necrotizing pancreatitis and among these the majority of about 18 patients had acute necrotizing pancreatic and peripancreatic collection. 147 patients (71%) had mild acute pancreatitis, 46 patients (22%) had moderately severe acute pancreatitis and 15 patients (7%) had severe acute pancreatitis. Among the 147 patients with mild acute pancreatitis, 146 had BISAP score less than 3 and only one had BISAP score greater or equal to three. Among the 46 patients graded as moderately severe acute pancreatitis, 37 had BISAP score of less than 3 and 9 had BISAP score greater than or equal to three. Among the 15 patients graded as severe acute pancreatitis, 2 had BISAP score of less than 3 and 13 had BISAP score greater than or equal to three. Twenty three patients corresponding to 11% had evidence of infection. Thirty-three (16%) patients required surgical intervention. Conclusion: There was a good correlation noted between the Revised Atlanta grading of severity and BISAP clinical scoring system in the prediction of clinical outcomes and need for intervention thus reducing the mortality rate. By combining these two (RAC and BISAP) powerful radiological and clinical tools we can triage, predict, treat the patients of acute pancreatitis with better accuracy and thereby creating a major impact in the betterment of medical care.