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Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study
Joseph Miller
Henry Ford Hospital, Detroit, MI, USA
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9451-1359
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.
Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes.
Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).
Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.
Keywords
Acute pancreatitis, predictive score, validation study, emergency department
Figure 1
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CURRENT STATUS: Under Revision
Review #2 received
Received 07 Dec, 2020
Editorial decision: Minor revision
On 07 Dec, 2020
Review #3 received
Received 30 Nov, 2020
Reviewer #4 agreed
On 26 Nov, 2020
Reviewer #3 agreed
On 21 Nov, 2020
Reviewer #2 agreed
On 20 Nov, 2020
Review #1 received
Received 19 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Editor assigned
On 07 Nov, 2020
Editor invited
On 07 Nov, 2020
Submission checks complete
On 07 Nov, 2020
Version 1
Posted 18 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 18 Oct, 2020
Review #2 received
Received 12 Oct, 2020
Review #1 received
Received 12 Oct, 2020
Reviewer #4 agreed
On 08 Oct, 2020
Reviewer #2 agreed
On 07 Oct, 2020
Reviewer #3 agreed
On 07 Oct, 2020
Reviewer #1 agreed
On 21 Sep, 2020
Reviewers invited
Invitations sent on 16 Sep, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 10 Sep, 2020
Metrics
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PDF Downloads: ...
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Subject Areas
Critical Care & Emergency Medicine
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This preprint is under consideration at BMC Emergency Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study
Joseph Miller
Henry Ford Hospital, Detroit, MI, USA
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9451-1359
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Review #2 received
Received 07 Dec, 2020
Editorial decision: Minor revision
On 07 Dec, 2020
Review #3 received
Received 30 Nov, 2020
Reviewer #4 agreed
On 26 Nov, 2020
Reviewer #3 agreed
On 21 Nov, 2020
Reviewer #2 agreed
On 20 Nov, 2020
Review #1 received
Received 19 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Editor assigned
On 07 Nov, 2020
Editor invited
On 07 Nov, 2020
Submission checks complete
On 07 Nov, 2020
Version 1
Posted 18 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 18 Oct, 2020
Review #2 received
Received 12 Oct, 2020
Review #1 received
Received 12 Oct, 2020
Reviewer #4 agreed
On 08 Oct, 2020
Reviewer #2 agreed
On 07 Oct, 2020
Reviewer #3 agreed
On 07 Oct, 2020
Reviewer #1 agreed
On 21 Sep, 2020
Reviewers invited
Invitations sent on 16 Sep, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 10 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.
Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes.
Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).
Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.
Figure 1