Tiny Tip: Ranson’s Criteria in Pancreatitis

In Medical Concepts, Tiny Tips by Doran Drew1 Comment

Editor’s Note: Last week we ran a tiny tip for the BISAP score which is an emergency department friendly way to evaluate the severity of disease. The more traditional RANSON criteria hasn’t gone completely out of style though. It may be particularly helpful when coordinating admission and prognosticating in those who will become inpatients. 

Ranson’s Criteria [1] is a well-validated clinical tool designed for the risk stratification of acute pancreatitis. Based on parameters collected at admission and at 48 hours post-admission, patients are assigned a score out of 11, and that score is used to predict mortality. Scores of 0-2 correspond to 1% mortality, 3-4 to 15% mortality, 5-6 to 40% mortality, and a score of 7 or more is associated with 100% mortality [2].

Some authors criticise Ranson’s Criteria because its dependence on a 48 hour time-point mitigates utility in guiding aggressive early management [1]. Nevertheless, the on-admission component of the score is useful for the emergency physician, as it can provide an impression of severity, guide disposition, and facilitate communication with surgical consultants..

Two mnemonics can help you remember Ranson’s Criteria: GA LAW (on admission) and Ca&HOBBS (post-admission);

Georgian law had issues with Calvin & Hobbs

On Admission

Glucose > 10mmol/L

AST > 250 U/L

LDH > 350 U/L

Age > 55 years

WBC > 16 x 109 cells/L

48 Hours Post-Admission

Calcium < 2.0 mmol/L

Hematocrit fall > 10%

O2 <60 mmHg

BUN increase from admission > 1.79 mmol/L

Base deficit > 4 mEq/L

Sequestrated fluids > 6L

Alternately, Dr. Teresa Chan has provided a different mnemonic in her staff review.

References

  1. Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, 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. 2010 Feb;105(2):435–41; quiz 442.
  2. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974 Jun;61(6):443–51.
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Doran Drew

Doran Drew

Queen's University, BScH, MD Candidate (2017)
Doran Drew
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