Introduction:
Acute pancreatitis (AP) is a condition with significant morbidity and mortality, where early identification of severe cases is crucial for timely management. Traditional scoring systems like APACHE II (Acute Physiology and Chronic Health Evaluation II), Ranson’s, BISAP, and the CT Severity Index (CTSI) have been used to define the severity but requires assessment at specific time-interval, specialized training and advanced equipment. While these scores effectively classify the severity of AP, they are less suited for monitoring of disease progression. In contrast MEWS offers rapid, cost-effective alternative that can be used for predicting severity especially in settings where imaging facilities may not be available.
Methods:
This study was conducted at a tertiary care center, enrolling 82 patients diagnosed with AP.This study aimed to evaluate the accuracy of MEWS compared to established scoring systems in the early prediction of Severe Acute Pancreatitis (SAP). MEWS was recorded every six hours for 48 hours, while APACHE II and Ranson’s score were calculated at 48 hours, BISAP within 24 hours, and the CT Severity Index at 72 hours. Severity was classified according to Revised Atlanta Criteria and Modified CTSI.The performance of each scoring system was evaluated by determining their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Results:
The study observed an overall mortality rate of 2.4%, with 22% of patients developing organ failure and 12.2% requiring ventilatory support. Notably, the cut-off where the highest MEWS exceeds 3 on days 0, 1, and 2 and the mean MEWS exceeds 3 on day 0 and 2 on days 1 and 2 achieved sensitivity of up to 92% and specificity of up to 91.2% when compared to the traditional scoring systems.
Conclusion:
The utility of the MEWS lies in its simplicity, allowing for rapid bedside prediction of mortality in SAP. While resource intensive scoring systems like APACHE II and CTSI can delay the rapid assessment which is much needed for pancreatitis. APACHE II and CTSI, while historically reliable, are more demanding in terms of time and resources.