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. 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.
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