All issues > Volume 38(12); 1995

Original Article

J Korean Pediatr Soc. 1995;38(12):1653-1663. Published online December 15, 1995.

Evaluation of Severity of Childhood Pancreatitis with Multiple Factor Scoring Systems

Young In YI Choi¹, Jeong Kee JK Seo¹

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea

Abstract

Purpose
: Pancreatitis in children is not common but can be associated with severe morbidity rates. Early prognostic evaluation of acute pancreatitis assists in selecting those patients who should be closely monitored. We studied the clinical characteristics and prognostic factors in patients with acute pancreatitis.
Methods
: Twenty five children with pancreatitis were included ranging in age from 1.8 to 14.9 years(l6 males and 9 females). We reviewed the records of the patients including analysis of etiology, symptoms at presentation, clinical course, complications, outcome, and calculation of the Ranson, Glasgow, APACHE II scores for patients with acute pancreatitis who visited our hospital initially or were transferred within 24 hours from other hospitals.
Results
: Trauma accounted for 24% of the cases of pancreatitis. Other etiologies were drugs(20%), postoperative(8%), anatomic causes(8%) and infection(4%). In 36% of cases, no causes were identified. Recurrence of acute pancreatitis were noted in 6 patients: idiopathic(3), trauma(l), postoperativeW, drug toxity(l). The cause of the case of chronic pancreatitis was idiopathic. All patients complained of abdominal pain. Vomiting was a common symptom and additional findings were anorexia, fever, abdominal distension, diarrhea and abdominal mass. Ranson(≥3), Glasgow(≥3) and APACHE II(≥lO on admission and peak scores during the first 3 days ≥12) scores can help to predict the severity of the disease, while amylase alone is not related to severity. Local complications were pancreatic ascites(10), pseudocyst(8), and obstructive jaundiceW. Systemic complications were hyperglycemia(4), pleural effusion(3), sepsis(3), DIC(3), UGI bleeding(2), renal failure(2), shock(2), metabolic acidosis(2), ventricular fibrillation(l), hypocalcemia(l), and hyperkalemia(l). Overall mortality rate was 8%. Supportive medical care were the mainstays of treating acute pancreatitis and two patients with choledocal cyst had operative procedures. Pancreatic pseudocysts occurred in 32% of our cases but in 50% of cases of traumatic pancreatitis, and they were managed with external drainage(4 patient), percutaneous external catheter drainage(2 patients).
Conclusion
: The causes of pancreatitis in children are diverse. Careful history taking and examination of patients with abdominal pain is mandatory not only to diagnose pancreatitis but also to find the etiology. The risk factors for severity of disease applied to adult populations are also useful in predicting morbidity and mortality rates in pediatric populations. In our study, Ranson, Glasgow and APACHE II scoring system is helpful to predict occurrence of complication and to select patients who need close monitoring.

Keywords :Pancreatitis, Trauma, Pseudocyst, Prognostic factors