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While many scoring systems and markers have been recognized and validated, most have only modest accuracy (see Table 4.1) [6]. For practicing clinicians, a severity prediction tool should ideally help change management of a patient based on the prognostic forecast given by the tool. An excellent example of a useful prediction tool is the Model for End‐Stage Liver Disease (MELD) score in patients with cirrhosis [79,80]. MELD score had long been used as a tool to assign priorities for liver transplants, and appropriately risk‐stratify cirrhotic patients undergoing surgery and transjugular intrahepatic portosystemic shunt [79,80]. In contrast, it is not known if any of the existing acute pancreatitis severity prediction tools influence clinical management.

Given the abundance of scoring systems, the next priority is to examine which of the systems directly impact management in real clinical settings. While SIRS score represents the most promising candidate for such practical use, there is lack of data on which is most useful at a clinical practice level. Even in patients with severe pancreatitis as defined by Revised Atlanta Classification, many could be managed on a regular nursing floor if the end‐organs do not require inotropes, mechanical ventilation, or renal replacement therapy. In a large multicenter prospective cohort study, 28% of severe AP patients were managed on the regular nursing floor [81]. In this context, some practical end points could include “impending” need for ICU admission or organ support requirement, need for a full admission from the emergency room, progression to multisystem organ failure, and early death. Almost all existing scoring systems predict in‐hospital mortality. While relevant, they do not consider where in the course of disease the death occurs.