Taylor et al developed the Multiple Organ System Score (MOSS) for evaluating a patient with acute pancreatitis. This can help identify a patient who may have more severe disease and a longer hospitalization. The authors are from the University of Oklahoma Health Sciences Center in Oklahoma City.
Outcome was measured as length of hospitalization as opposed to morbidity or mortality.
Parameters using admission values:
(1) age
(2) pulse
(3) mean arterial pressure (MAP) in mm Hg
(4) body mass index (BMI)
(5) BUN
(6) creatinine
(7) arterial saturation for oxygen on room air
(8) total bilirubin in mg/dL
(9) AST in IU/L
(10) alkaline phosphatase in IU/L
(11) prothrombin time (PT) in seconds
(12) activated partial thromboplastin time (aPTT) in seconds
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
<= 50 years of age |
0 |
|
|
> 50 years of age |
1 |
|
body mass index |
< 18.5 kg per square meter |
1 |
|
|
18.5 to 25 kg per square meter |
0 |
|
|
> 25 kg per square meter |
1 |
|
pulse |
<= 100 beats per minute |
0 |
|
|
> 100 beats per minute |
1 |
|
mean arterial pressure |
< 70 mm Hg |
1 |
|
|
70 to 110 mm Hg |
0 |
|
|
> 110 mm Hg |
1 |
|
BUN |
<= 20 mg/dL |
0 |
|
|
> 20 mg/dL |
1 |
|
creatinine |
<= 1.4 mg/dL |
0 |
|
|
> 1.4 mg/dL |
1 |
|
arterial oxygen saturation |
>= 90% |
0 |
|
|
< 90% |
1 |
|
total bilirubin |
<= 1.1 mg/dL |
0 |
|
|
> 1.1 mg/dL |
1 |
|
AST |
<= 30 IU/L |
0 |
|
|
> 30 IU/L |
1 |
|
alkaline phosphatase |
<= 95 IU/L |
0 |
|
|
> 95 IU/L |
1 |
|
PT |
<= 13.6 seconds |
0 |
|
|
> 13.6 seconds |
1 |
|
aPTT |
<= 32 seconds |
0 |
|
|
> 32 seconds |
1 |
where:
• The values for the hematology (and presumably the chemistry tests) were based on the normal ranges at the University of Oklahoma Medical Center (page 220).
total MOSS =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the more severe the acute pancreatitis.
• A cutoff of >= 3 indicated patients with severe disease.
Performance at cutoff:
• The sensitivity was 86% and specificity 50%.
• The positive predictive value was 61% and negative predictive value 81%.
• The ROC curve area was 0.71.
• The score performed better than the APACHE II, modified Glasgow and Ranson scores.
Purpose: To evaluate a patient admitted to the hospital with acute pancreatitis using the Multiple Organ System Score (MOSS) of Taylor et al.
Specialty: Gastroenterology
Objective: severity, prognosis, stage, disease progression
ICD-10: K85,
