Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 86

Practice guidelines recommend against the use of early CT imaging [1,5,44]. Despite this, early imaging is performed in 40–70% of cases [45–47]. A predictive model for the diagnosis of AP aimed to decrease the use of imaging was developed using the following predictors: number of prior AP episodes; history of cholelithiasis; no abdominal surgery (prior two months); time elapsed from symptom onset; pain localized to epigastrium; progressively worsening severity; severity level at presentation; and lipase levels five or more times the upper limit of normal [48]. Those with all eight predictors were identified to have AP with a sensitivity of 45%, and a specificity and a positive predictive value of 100% [46]. Studies have shown that early CT imaging does not predict development of pancreatic necrosis, improve clinical outcomes or reduce length of hospital stay [27,45,46,49–52]. Patients with severe AP who do not improve with conservative therapy or have worsening disease, including the development of organ failure, will benefit from CT imaging. Evidence shows that the optimal time to obtain CT imaging is 48–72 hours after presentation [1,53].