Study Establishes New CT Severity Index for Patients with Acute Pancreatitis

To better predict the outcomes of patients suffering from acute pancreatitis, a new study, published in the November 2004 issue of the American Journal of Roentgenology , presents a more predictive modified CT severity index (M-CTSI). Results from using the M-CTSI show more significant correlation between moderate and severe levels of acute pancreatitis and patient outcomes, such as length of hospital stay and development of organ failure, than the currently accepted CT severity index.

Established in 1994, the current widely used CT severity index helps discriminate between mild, moderate, and severe forms of pancreatitis by focusing on the presence of pancreatic inflammation and necrosis. The system has been successful in determining the morbidity and mortality of patients with acute pancreatitis, but does not help predict subsequent development of organ failure, extrapancreatic parenchymal complications, or peripancreatic vascular complications. Researchers at the Brigham and Women’s Hospital, Boston, speculated that an enhanced CT severity index, which reflects measures of organ failure and extrapancreatic complications, would be more useful for predicting patient outcomes.

“In cases where severe pancreatitis can be established early on, based on a high M-CTSI score, it would lead to more aggressive early treatment, such as prompt transfer to the intensive care unit, better fluid resuscitation, careful respiratory monitoring, and possibly earlier enteral feeding,” says Koenraad J. Mortele, lead author of the study. His research team established the M-CTSI, which differs from the currently used CT severity index with the addition of a simplified evaluation of the presence and number of fluid collections, the extent of pancreatic necrosis (zero, minimal, or substantial), and the assessment of extrapancreatic complications.

For the study, a retrospective review of 266 patients who had a primary diagnosis of acute pancreatitis was performed. Of these 266 patients, 66 patients underwent contrast-enhanced CT within 1 week of onset of symptoms, while 19 patients underwent their first contrast-enhanced CT more than 1 week after initial onset of symptoms; 105 patients underwent no cross-sectional imaging; 8 patients underwent MRI; and 68 patients underwent unenhanced CT imaging.

CT scans were reviewed retrospectively and independently on PACS workstations by three abdominal radiologists. The severity of pancreatitis for each case was assessed by each observer using the traditional CT severity index and the M-CTSI, and the severity was categorized as mild, moderate, or severe. Outcome parameters included the length of the hospital stay (in days), need for surgical intervention, need for percutaneous intervention (aspiration and drainage), evidence of infection in any organ system, and evidence of organ failure.

Using the currently accepted CT severity index, the observers graded the severity of the acute pancreatitis as mild in 42 patients, moderate in 19 patients, and severe in 5 of the 66 patients of whom CT scans were obtained. Interobserver agreement on these observations ranged from 74% to 83%. Using the M-CTSI, the observers graded severity of the acute pancreatitis as mild in 34 patients, moderate in 22 patients, and severe in 10 of the 66 patients with CT scans; observers agreed on these grades in 70% to 79% of the cases.

Overall results showed that the total length of hospital stays for all patients ranged from 0 to 34 days. Ten of the 66 patients underwent surgical or percutaneous interventions. Surgical debridement was performed in four patients; percutaneous CT-guided needle aspiration of pancreatic fluid collections was performed in seven patients, and percutaneous CT-guided catheter drainage of pancreatic fluid collections was performed in four patients. Evidence of infection was present in 21 of the 66 patients. Organ system failure was present in nine patients, including failure of the heart pulmonary system, central nervous system, and kidneys.

Except as noted, data are numbers (%) of patients. Source: AJR:183, November 2004

When evaluating the correlation of the patient outcome measures between the different indexes, the M-CTSI showed a more significant relationship. For example, strong correlation was seen between the pancreatitis severity level and length of hospital stay for all severity groups – 3 days for mild pancreatitis, 8 days for moderate pancreatitis, and 12 days for severe pancreatitis (see Table 1). Using the current CT severity index, no significant correlation was seen between the length of hospital stay in moderate and severe pancreatitis groups, which showed 9 and 11 hospital stay days, respectively (see Table 2). The M-CTSI also showed greater correlation with the need for surgical or percutaneous interventions, the presence of infection, and the development of organ failure.

Except as noted, data are numbers (%) of patients. Source: AJR:183, November 2004

New Code Alert

The American Medical Association (AMA) has established a new Current Procedural Terminology (CPT®) code for DXA procedures utilizing bone densitometers that provide imaging of the spine in assessing the presence of vertebral fractures. The new code, Vertebral Fracture Assessment 76077, is published in the 2005 edition of the AMA’s Current Procedural Terminology.

All You Need Is Love

To help scientists discover if the human brain can change based on purely internal, mental signals, as opposed to conventional scientific belief that brain changes reflect physical experience and input from the outside world, Buddhist monks in Dharamsala, India, recently took part in an experiment where they meditated on the most basic of human emotionslove.

A story appearing in a recent issue of The Wall Street Journal highlighted the study. Researchers examined the brain activity of volunteer amateur meditators to that of Buddhist monks who had spent more than 10,000 hours in meditation. They performed “compassion” meditation, generating a feeling of loving kindness toward all beings. The experienced monks showed a dramatic increase in high-frequency brain activity called gamma waves, which are thought to be the signature of neuronal activity between brain circuits.

Scientists used functional magnetic resonance imaging to pinpoint regions that were active during compassion meditation. In mostly all the cases, the enhanced activity was greater in the monks’ brains versus the amateurs’ brains. A purely mental activity had produced a completely novel phenomenon: activity in the left prefrontal cortex (the site of positive emotions) overtook activity in the right prefrontal cortex (the site of negative emotions and anxiety). Researchers also noticed increased brain activity in a circuit that switches on at the sight of suffering, and in the regions responsible for planned movement, as if the monks’ brains wanted to aid those in distress.

Scientists reportedly gained confidence that changes to the brain, as seen by the meditation power of the monks, can occur by mental training. The study will be published in the Proceedings of the National Academy of Sciences.

Industry News

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