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. 2019 Oct:213:143-148.e2.
doi: 10.1016/j.jpeds.2019.06.028. Epub 2019 Aug 6.

Sensitivity of Biochemical and Imaging Findings for the Diagnosis of Acute Pancreatitis in Children

Sarah H Orkin  1 , Andrew T Trout  2 , Lin Fei  3 , Tom K Lin  4 , Jaimie D Nathan  5 , Tyler Thompson  1 , David S Vitale  4 , Maisam Abu-El-Haija  6
Affiliations

Sensitivity of Biochemical and Imaging Findings for the Diagnosis of Acute Pancreatitis in Children

Sarah H Orkin et al. J Pediatr. 2019 Oct.

Abstract

Objective: To determine the diagnostic sensitivity of serum biomarkers and imaging in the diagnosis of acute pancreatitis in children.

Study design: This was a cross-sectional analysis of prospective registry data for children (age <21 years) whose first documented attack of acute pancreatitis occurred between March 2013 and October 2016 at a single-institution, tertiary care center. Main outcome was sensitivity of serum biomarkers and of imaging modalities, measured via descriptive statistics.

Results: In total, 112 children met the criteria for acute pancreatitis; 57 (51%) were male with a median age of 13.4 years (IQR 9.3-15.8 years). Serum amylase and lipase levels were obtained in 85 (76%) and 112 (100%) patients, respectively. Imaging was performed in 98 (88%) patients, with abdominal ultrasound (US) performed in 84 (75%) and computed tomography and/or magnetic resonance imaging performed in 46 (41%) patients. Fifty-three (47%) patients met all 3 diagnostic criteria (clinical, biochemical, and imaging) for acute pancreatitis. Laboratory testing had a 5.4% false-negative rate for acute pancreatitis. Serum lipase alone and amylase alone were 95% (95% CI 89%-98%) and 39% (95% CI 28%-50%) sensitive for acute pancreatitis, respectively. Imaging (any modality) was 61% sensitive (95% CI 51%-71%) for acute pancreatitis with a 34% false-negative rate. US alone was 52% (95% CI 41%-63%) sensitive for acute pancreatitis and computed tomography/magnetic resonance imaging was 78% (95% CI 63%-89%) sensitive. Combinations of diagnostic criteria performed no better than laboratory testing alone.

Conclusions: The majority of children coming to medical attention with their first documented occurrence of acute pancreatitis have characteristic symptoms. Serum lipase is highly sensitive for the diagnosis of acute pancreatitis, and serum amylase is moderately sensitive. Imaging, particularly US, is only moderately sensitive, and cross-sectional imaging provides greater sensitivity for diagnosing acute pancreatitis.

Keywords: amylase; computed tomography scan; lipase; magnetic resonance imaging; ultrasound.

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