{Reference Type}: Journal Article
{Title}: Prospective Validation of a Prediction Model for the Diagnosis of Acute Pancreatitis.
{Author}: Jin DX;Lacson R;Eskian M;McNabb-Baltar J;Banks PA;Kayden SR;Raja AS;Khorasani R;
{Journal}: JAMA Netw Open
{Volume}: 7
{Issue}: 6
{Year}: 2024 Jun 3
{Factor}: 13.353
{DOI}: 10.1001/jamanetworkopen.2024.19014
{Abstract}: <B>UNASSIGNED: </B>While most patients with acute pancreatitis (AP) fulfill diagnostic criteria with characteristic abdominal pain and serum lipase levels of at least 3 times the upper limit of normal (reference range) at presentation, early imaging is often used for confirmation. A prior prediction model and corresponding point-based score were developed using nonimaging parameters to diagnose AP in patients presenting to the emergency department (ED).<BR><B>UNASSIGNED: </B>To evaluate the performance of the prediction model to diagnose AP in a prospective patient cohort.<BR><B>UNASSIGNED: </B>This prospective diagnostic study included consecutive adult patients presenting to the ED between January 1, 2020, and March 9, 2021, at 2 large academic medical centers in the northeastern US with serum lipase levels at least 3 times the upper limit of normal. Patients transferred from outside institutions or with malignant disease and established intra-abdominal metastases, acute trauma, or altered mentation were excluded. Data were analyzed from October 15 to October 23, 2023.<BR><B>UNASSIGNED: </B>Participants were assigned scores for initial serum lipase level, number of prior AP episodes, prior cholelithiasis, abdominal surgery within 2 months, presence of epigastric pain, pain of worsening severity, duration from pain onset to presentation, and pain level at ED presentation.<BR><B>UNASSIGNED: </B>A final diagnosis of AP, established by expert review of hospitalization records.<BR><B>UNASSIGNED: </B>Prospective scores in 349 participants (mean [SD] age, 53.0 [18.8] years; 184 women [52.7%]; 66 Black [18.9%]; 199 White [57.0%]) demonstrated an area under the receiver operating characteristics curve of 0.91. A score of at least 6 points achieved highest accuracy (F score, 82.0), corresponding to a sensitivity of 81.5%, specificity of 85.9%, positive predictive value of 82.6%, and negative predictive value of 85.1% for AP diagnosis. Early computed tomography or magnetic resonance imaging was performed more often in participants predicted to have AP (116 of 155 [74.8%] with a score ≥6 vs 111 of 194 [57.2%] with a score <6; P < .001). Early imaging revealed an alternative diagnosis in 8 of 116 participants (6.9%) with scores of at least 6 points, 1 of 93 (1.1%) with scores of at least 7 points, and 1 of 73 (1.4%) with scores of at least 8 points.<BR><B>UNASSIGNED: </B>In this multicenter diagnostic study, the prediction model demonstrated excellent AP diagnostic accuracy. Its application may be used to avoid unnecessary confirmatory imaging.