Lankisch et al reported the Harmless Acute Pancreatitis Score (HAPS) to identify harmless cases of acute pancreatitis. This can help to identify mild cases of acute pancreatitis that can be handled conservatively. The authors are from the Municipal Clinic of Luneburg, the European Institute of Oncology in Milan and New York Medical College.
Patient selection: acute pancreatitis
Criteria for a harmless course:
(1) no evidence of pancreatic necrosis on the Balthazar score
(2) no need for dialysis
(3) no need for artificial ventilation
(4) no fatalities
Parameters:
(1) serum creatinine in mg/dL
(2) hematocrit in percent
(3) rebound tenderness and guarding (signs of peritonitis)
Parameter
|
Finding
|
Points
|
serum creatinine
|
< 2 mg/dL
|
1
|
|
>= 2 mg/dL
|
0
|
hematocrit
|
normal
|
1
|
|
abnormal
|
0
|
rebound tenderness or guarding
|
absent
|
1
|
|
present
|
0
|
where:
• Lankisch et al used a hematocrit > 43% in men and > 39.6% for women as abnormal.
• Oskarsson et al used hemoglobin and appears to have included anemia as abnormal.
• Serum creatinine is abnormal if >= 2.0 mg/dL in the text and > 2.0 mg/dL in Table 1.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• A patient with a score of 3 (the 3 parameters are normal) is expected to have a harmless disease course.
• About 2% of patients designated harmless had severe disease in the initial study.