Jssn Vol 17 No1_final to print copy.pdf


JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Early warning score in predicting the severity of acute 

pancreatitis

Poudyal S, Singh YP

Correspondence:

Abstract

Introduction: 

warning score and severity of pancreatitis.

Methods:

Results:

Conclusion:

complications of acute pancreatitis.

Keywords:

Introduction

and mortality worldwide. Severe pancreatitis may 

develop in approximately a third of the patients resulting 

in progressive organ dysfunction which is usually caused 

1

important to determine the severity of the disease to 

anticipate complications and to manage them.3 Organ 
3

disease and avoidance of complications. So various scoring 

It has its role 

in wards to evaluate the severity of any disease process and 

indirectly measures SIRS and helps in predicting the 

severity of the disease.

Original Article



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Methods

3

managed at other centers were excluded. Informed 

temperature, neurological status and urine output were 

recorded four hourly and as per necessary from the time of 

as per need of the patient. Severity of acute pancreatitis 
3

Results

Table 1. Early Warning Score

Score 3 2 1 0 1 2 3

Heart Rate 
((beats/min)

111-129

Systolic blood 
pressure 
(mmHg)

Respiratory
rate (/min)

<9

Temperature   
(°C)

Level of con-
sciousness

-
sponse

Pain re-
sponse

Urine output Nil
2 hours 2 hours 2 hours



18JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

any time was regarded as a predictor of severe pancreatitis. 

st, 2nd and 

3rd

Table 2).

Fig. 1). Similarly there 

.

and NPV of EWS in our study for predicting severity of 

Acute Pancreatitis

EWS-
24hr

EWS-
48hr

EWS-
72hr

EWS*

Sensitivity

98.38

Figure 1: Receiver Operating Characteristics Curve of 

EWS on Day 1, 2 and 3

Discussion

continuous as complications may occur at any time during 

admission.

mediated.

group of late deaths, the presence of organ dysfunction 

mortality.

according to severity3

high dependency unit timely.

is normally voiding the urine. 

In our study, severity increased with the age of the patient. 

Similar to previous studies, our study showed that males 

had more severe course of the disease than the females.8,

9

etiology and severity of the disease. Other studies have 



19JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

even in most cases of moderately severe pancreatitis from 

Figure 1).

in-patients.12

13  Similarly, Smith et al

operations, and severe complications in  surgical patients. 

considering the unprecedented nature of the disease process 

itself.

They have 

pancreatitis in terms of severity, critical care admission and 

patient need.  When compared to various scoring systems 

 (Table 3).

the early component that determines the severity in early 

the complications and helps in early management. With 

categorized severity into three grades-mild, moderately 

study. 

NPV for different scoring systems in various studies 

predicting severity of Acute Pancreatitis

Sensitivity PPV NPV

APACHE II (at 

admission)18-19

APACHE II (at 

48 hours)18-19

BALTHAZAR18-19

GLASGOW18-19

RANSON18-19

EWS24 Garcea 

et al.14

91.60 85.00 71.00 96.36

EWS24  current 

study
87.50 95.38 95.45 95.30

EWS* current 

study

Conclusion

pancreatitis. This will not replace the currently accepted 



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

in assessing repeatedly without any further cost and 

every case of acute pancreatitis to assess its evolution and 

complications.

References

1.

2.

for acute pancreatitis. Summary of the International 

3.

.

8.

infections and death in severe acute pancreatitis. 

9.

and severity. Scandinavian Journal of Surgery 

11.

12.

13.

of patients. Postgrad Med J.

warning scores predict outcome in acute pancreatitis.J

18.

necessity of re - evaluation of scoring systems according 

19.

severity and progression of acute pancreatitis. Best