Tiny Tip: BISAP for Pancreatitis

EDITOR’S NOTE: I often struggle with determining whether the presentation is pancreatitis or whether it’s PANCREATITIS. There are a number of scoring systems to help evaluate this question but one in particular is nicely suited to the Emergency Department. I like Doran’s Tiny Tip that can help you remember some of the key features to consider. – EP

The severity and sequelae of acute pancreatitis range wildly, from mild epigastric pain with a benign natural history to multiple organ dysfunction necessitating ICU admission[1]. This variability poses a dilemma for emergency physicians, as diagnosis does not clearly dictate disposition. While Ranson, APACHE II, and CTSI scoring systems have been validated for risk-stratification, these tools are geared towards evaluation of the pancreatitis inpatient after extensive workup and are not amenable to use in the emergency department[2].

This conundrum has led to development of the Bedside Index of Severity in Acute Pancreatitis (BISAP), a simple tool ideal for rapid risk-stratification[2,3]. The tool is based on a 5-point score, derived from 5 parameters collected within a patient’s first 24 hours in hospital. Conveniently, the parameters of the BISAP score can be used to spell BISAP, making for an easy-to-remember mnemonic.

Blood Urea Nitrogen > 8.92 mmol/L

Impaired mental status,

≥2 SIRS Criteria,

Age > 60 years

Pleural effusion on chest X-ray or CT

References

[1] E.L. Bradley, A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992., Arch. Surg. 128 (1993) 586–90.

[2] G.I. Papachristou, V. Muddana, D. Yadav, M. O’Connell, M.K. Sanders, A. Slivka, et al., Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis., Am. J. Gastroenterol. 105 (2010) 435–41; quiz 442. doi:10.1038/ajg.2009.622.

[3] B.U. Wu, R.S. Johannes, X. Sun, Y. Tabak, D.L. Conwell, P.A. Banks, The early prediction of mortality in acute pancreatitis: a large population-based study., Gut. 57 (2008) 1698–703. doi:10.1136/gut.2008.152702.