Balthazar_score_guideline v.1

The Balthazar score or the Computed Tomography Severity Index (CTSI) as it is also known, evaluates the pancreatitis grade and necrosis to determine a severity score.

Maryam Razavi

maryam.razavi@cambio.se

© Cambio CDS

To evaluate the severity of AP based on the Balthazar grading and necrosis percentage.

Variables: The Balthazar Grade component of the score is: - Grade A – Normal CT; - Grade B – Focal or diffuse enlargement of the pancreas (Edematous Pancreas); - Grade C – Pancreatic gland abnormalities and peripancreatic inflammation; - Grade D – Fluid collection in a single location; - Grade E – Multiple or extensive fluid collections and / or gas bubbles in or adjacent to pancreas. The Necrosis score component of the model is: - No necrosis; - 0 to 30% necrosis; - 30 to 50% necrosis; - Over 50% necrosis Formula: CT severity index/ Balthazar Score = CT grade points + Necrosis points The results are correlated with the three degrees of acute pancreatitis severity: - 0 – 3 points indicate mild AP - 4 – 6 points indicate moderate AP - 7 – 10 points indicate severe AP.

Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology. 1994 Nov;193(2):297-306. doi: 10.1148/radiology.193.2.7972730. PMID: 7972730. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002 Jun;223(3):603-13. doi: 10.1148/radiol.2233010680. PMID: 12034923. Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol. 2012 Apr;107(4):612-9. doi: 10.1038/ajg.2011.438. Epub 2011 Dec 20. PMID: 22186977. Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatitis outcome. J Clin Gastroenterol. 2003 Mar;36(3):253-60. doi: 10.1097/00004836-200303000-00013. PMID: 12590238. Raghuwanshi S, Gupta R, Vyas MM, Sharma R. CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index. J Clin Diagn Res. 2016 Jun;10(6):TC06-11. doi: 10.7860/JCDR/2016/19849.7934. Epub 2016 Jun 1. PMID: 27504376; PMCID: PMC4963736.

OBSERVATION.balthazar.v0, EVALUATION.balthazar_assessment.v0