Balthazar CT Severity Index

Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: value of CT in establishing prognosis. Introduced the CT severity index (morphology grade A–E plus the extent of necrosis on contrast-enhanced CT, summed 0–10) in 88 patients: necrosis was associated with 23% mortality and an 82% complication rate, versus 0% mortality and 6% morbidity without necrosis.

CT is not required to diagnose acute pancreatitis and is usually unnecessary in the first 48–72 hours unless the diagnosis is uncertain or the patient fails to improve — pancreatic necrosis is often not yet demarcated on an early scan. Combine the CTSI with a clinical severity score (BISAP, Ranson) and the patient’s trajectory rather than using it alone to guide early management.