Background: Chronic pancreatitis (CP) is characterised by pain, nutritional deficiencies, and mechanical complications. Frequently managed in out-patient settings, the clinical course is unpredictable and requires multi-disciplinary care. Unlike acute pancreatitis, there are no dominant scoring models to predict patient outcomes or compare interventions. There remains substantial variation in management. We conducted a systematic review to determine the scope and clinical use of existing scoring systems.
Methods: A systematic search was developed with a medical librarian using the Embase, Medline and Cochrane databases. Original articles and conference abstracts describing an original or modified scoring system in CP that classified patients into severity categories were included. To assess clinical application/validation, studies using all or part of a score as a stratification tool were selected. Studies reporting on diagnosis only were excluded. Two authors performed the search and conflicts were resolved by a third author using CovidenceTM systematic review software.
Results: From screening 6,652 titles and 235 full-text reviews, 47 papers were analysed. Eleven described original scores, and 6 described modifications of published scores. Many were comprehensive, but limited in capturing the full spectrum of disease. In 30 studies, a score was used to group patients for various outcome measures. Only one score had been objectively validated for monitoring progression and prognosis, but was only applied to in-patients.
Conclusions: Current scores do not reflect recent advances and guidelines in CP, and are not widely used. A scoring system for practical clinical classification and prognostication would be useful for meaningful analysis in observational and interventional studies in CP.
