PATIENT SELECTION AND TIMING OF DYNAMIC COMPUTED-TOMOGRAPHY IN ACUTE-PANCREATITIS

Dynamic computed tomography (CT) is the most accurate method for deter mining the extent of necrosis in acute pancreatitis. Debate exists, ho wever, regarding patient selection and the optimal timing of CT. This study examined selection based on biochemical and/or clinical criteria and the influence of delayed dynamic CT performed 5-10 days after the onset of an attack. A total of 120 patients with acute pancreatitis w ere studied. Dynamic CT was performed if any of the following criteria were identified: a biochemically severe attack (according to Glasgow criteria) in the first 24 h, C-reactive protein (CRP) level above 120 mg/l in the first 3 days or failure of clinical resolution within 7 da ys. Of 42 patients selected for CT,five died from multisystem organ fa ilure before day 5. There were no deaths or delayed complications in t he 78 patients not selected for scanning. Positive Glasgow criteria al one in the scanned group had a sensitivity for predicting necrosis (as recognized by CT) of 22 per cent and a sensitivity of 20 per cent. Me asurement of CRP level alone had a sensitivity of 26 per cent and spec ificity of 80 per cent. Failure of clinical resolution had a sensitivi ty of only 7 per cent but a specificity of 100 per cent. The combinati on of Glasgow criteria and CRP level had a sensitivity of 44 per cent and specificity of 100 per cent. Delayed complications (pseudocyst, Ji ve; infection, six) occurred only in patients with necrosis, and there were two deaths. An 'at-risk' group can be identified for CT on the b asis of biochemical and clinical observations. Neither routine nor eme rgency dynamic CT in acute pancreatitis seems justified.