RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE & ADDRESS / DR ASHWINI C POST GRADUATE IN GENERAL SURGERY , KIMS, HUBLI-22
2 / NAME OF THE INSTITUTION / KARNATAKA INSTITUTE OF MEDICAL SCIENCES, HUBLI-580022
3 / COURSE OF STUDY AND SUBJECT / MS IN GENERAL SURGERY
4 / DATE OF ADMISSION TO THE COURSE / 11th JUNE 2010
5 / TITLE OF TOPIC / COMPARATIVE STUDY OF RANSON’S VERSUS APACHE 2 SCORING SYSTEM IN PREDICTING CLINICAL OUTCOME IN PATIENTS WITH ACUTE PANCREATITIS ADMITTED TO KIMS, HUBLI.
6 / BRIEF RESUME OF INTENDED WORK:
6.1 Need for study:
Acute pancreatitis is quite commonly encountered in routine surgical practice. It includes a wide spectrum of disease from one with mild self-limiting symptoms, to fulminant processes with multiorgan failure. Mortality rate ranges from less than 1 % in mild cases to 20-50% in severe cases. Thus in severe pancreatitis it is important clinically to predict prognosis at the time of admission. There have been numerous advances in diagnosis and treatment of acute pancreatitis. But ability to predict outcome in these cases remains difficult. Several scoring systems have been proposed including Ransons and APACHE. There is a need to find out efficacy of these scoring systems in predicting prognosis and whether one system has any advantage over the other.
6.2 Review of Literature
1.  Yuk Pang Yeung, Billy Yeung Kit Lam and Andrew Wai Chun Yip1 in 2006 studied 101 cases of acute pancreatitis. Ranson score, APACHE-¢ò and APACHE-O scores were recorded on admission and at 48 hours for all the patients. They concluded that APACHE-¢ò scoring system is more accurate than the Ranson scoring system for predicting severity of acute pancreatitis. Addition of obesity score does not significantly improve the predictive accuracy of the APACHE-¢ò system.
2.  Stephaniel et al2 in 2005 did a retrospective review of 49 patients with acute pancreatitis. Ranson’s , Glasgow and APACHE 2 scores were recorded in all the patients. They concluded that Glasgow scoring system more closely correlated with clinical outcome compared to other 2 scoring systems.
3.  S.Conner et al3 in 2003 published a retrospective review of 64 patients who underwent surgery for acute pancreatitis. They found that advanced age and APACHE 2 score were most important predictors of outcome in patients of severe acute pancreatitis undergoing surgery.
4.  Arif khan et al4 in 2002 did a retrospective study of 125 patients of acute pancreatitis admitted between December 1, 1996, and August 31, 1999. Patients with severe acute pancreatitis as defined by 3 or more Ranson criteria or a hospital stay of longer than 6 days only were included in this study. They found improved predictive value of APACHE 2 when calculated at 48 hrs after admission compared to that on admission.
5.  Michael Larvin and Michael McMohan in 1989 studied 290 patients of acute pancreatitis. Ranson’s and APACHE 2 scores were recorded in all patients. The results of the 2 scoring systems were compared. They concluded that APACHE 2 may facilitate rapid selection of patients for more intensive therapy.
6.3 Objectives of study:
To compare the efficacy of Ranson’s and APACHE 2 scoring systems in predicting outcome in cases of acute pancreatitis.
7 / MATERIALS AND METHODS:
7.1 Source of data:
Patients admitted to surgical wards in KIMS hospital, Hubli over a period of 1 year from 01\12\2010 to 30\11\2011 with diagnosis of acute pancreatitis will be included in the study.
7.2 Type of the study:
Prospective hospital based time bound study.
Inclusion Criteria :
Patients with history and clinical findings suggestive of acute pancreatitis with evidence of bulky edematous pancreas on USG\ CT abdomen.
Exclusion Criteria:
Patients with history and clinical findings suggestive of acute pancreatitis but no radiological evidence of the same.
7.3 Methods of collection of data:
·  The study will be prospective hospital based study. All those cases which satisfy the inclusion criteria will be included in the study.Duration of the study will be for one year from 01-12-2010 to 30-11-2011.
·  A detailed history and clinical examination will be carried out for each case as outlined in the proforma.Diagnosis is made based on serum amylase and USG\CT abdomen.
·  All investigations required for Ranson’s and APACHE 2 scoring system will be sent and score will be calculated. Patient will be followed till discharge. Scores will be compared to clinical outcome.
7.4 Does the study require any investigation to be conducted on patients or animals specify.
Yes
The following investigations will be done in all cases
1.  WBC count
2.  Blood glucose
3.  Sr. LDH
4.  Sr. AST
5.  PCV
6.  Blood Urea Nitrogen
7.  Sr. Calcium
8.  ABG analysis
9.  Sr. Amylase
7.5 Has the ethical clearance been obtained from ethical committee of your Institution in case of 7.4?
“Yes”, ethical clearance has been obtained.
Statistical Analysis
Results will be analyzed by using appropriate statistical tests.
8 / LIST OF REFERENCES
1.  Yuk Pang Yeung, Billy Yeung Kit Lam and Andrew Wai Chun Yip ‘APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis’ Hepatobiliary Pancreat Dis Int 2006;5(294-299).
2.  Stephaniel et al ‘A comparision of Ranson, Glasgow and APACHE 2 scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis’ Am J Sur 2005; 189; 219-222.
3.  S.Connor et al ‘Increasing age and APACHE 2 scores are main determinants of outcome from pancreatic necrosectomy’ Br J sur 2003; Dec; 1542-1549.
4.  Arif A et al ‘Improved Prediction of Outcome in Patients With Severe Acute Pancreatitis by the APACHE II Score at 48 Hours After Hospital Admission Compared With the APACHE II Score at Admission’ Arch Surg.2002;137; 1136-1140.
5.  Michael Larvin and Michael McMohan ‘ APACHE 2 score for assessment and monitoring of acute pancreatitis’ Lancet1989;2 ; 201-205.
9 / SIGNATURE OF CANDIDATE
10 / REMARKS OF THE GUIDE / It is possible to do this project work at KIMS, Hubli.
11 / NAME & DESIGNATION
11.1 GUIDE / DR. SHILPA H. ASSOCIATE PROFESSOR, DEPARTMENT OF SURGERY, KIMS, HUBLI.
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT / DR.B.S.MADAKATTI PROFESSOR & HEAD, DEPARTMENT OF SURGERY, KIMS, HUBLI.
11.6 SIGNATURE
12 / 12.1 REMARKS OF CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE