Pancreatitis Clinical Pathway — Emergency Department and Inpatient

Determine Severity of Illness

Determination made by the most severe criteria. For example, a child with necrotizing pancreatitis with amylase/lipase elevation but no other lab abnormalities would still be classified as "Moderate.
Presence of systemic inflammatory response syndrome is associated with increased risk for persistent organ dysfunction.

	Mild No organ failure (pancreatic or systemic)	Moderate Transient organ failure, pancreatic complications or exacerbation of co-morbid disease	Severe Persistent organ failure, fluid overload, shock
Clinical Signs/Symptoms	Able to tolerate PO Pain improves with PO/IV medications	Jaundice/icterus present Oliguria Not able to tolerate PO Pain refractory to PO medications	Altered mental status Anuria Cullen sign Grey-Turner sign Not able to tolerate PO Pain refractory to IV medications
Vital Sign Abnormalities See SIRS criteria below	None	1	≥ 2
Labs	Amylase elevation Lipase elevation	Leukocytosis Hypoalbuminemia BUN or creatinine elevation Hyperbilirubinemia CRP or procalcitonin elevation if obtained
Imaging Abnormalities May vary based on modality	Interstitial/edematous pancreatitis Peripancreatic edema	Necrotizing pancreatitis Peripancreatic fluid collection	Hemorrhage Portal vein thrombosis

Reference

Classification of Acute Pancreatitis in the Pediatric Population: Clinical Report From the NASPGHAN Pancreas Committee (2017)

SIRS Vital Sign Criteria

Temperature	≥ 38°C or < 36°C
Heart Rate	≥ 12 mos Elevated > 2SD above normal for age in the absence of external factors such as associated fussiness, crying, or irritability or Unexplained persistent elevation over a 30 min to 4 hr time period < 12 mos Decreased heart rate < 10^th percentile for age in the absence of external factors such as vagal stimulation or medications or Unexplained persistent depression over a 30 min time period
Respiratory Rate	> 2SD above normal for age or Requiring mechanical ventilation for an acute process not related to underlying disease

Temperature

≥ 38°C or < 36°C

Heart Rate

≥ 12 mos
- Elevated > 2SD above normal for age in the absence of external factors such as associated fussiness, crying, or irritability or
- Unexplained persistent elevation over a 30 min to 4 hr time period

< 12 mos
- Decreased heart rate < 10^th percentile for age in the absence of external factors such as vagal stimulation or medications or
- Unexplained persistent depression over a 30 min time period

Respiratory Rate

> 2SD above normal for age or
Requiring mechanical ventilation for an acute process not related to underlying disease

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Pancreatitis Clinical Pathway — Emergency Department and Inpatient

Determine Severity of Illness

Reference

SIRS Vital Sign Criteria

Find a research study

Innovation and your child

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Pancreatitis Clinical Pathway, Emergency Department and Inpatient – Determine Severity of Illness

Pancreatitis Clinical Pathway — Emergency Department and Inpatient

Determine Severity of Illness

Reference

SIRS Vital Sign Criteria