I was reviewing gastrointestinal (GI) disorders. The topic of Acute Pancreatitis came up, and I was trying to devise a good memory tool for recalling the Ranson’s Criteria. Ranson’s Criteria is a prognostic tool used to estimate mortality of patients with pancreatitis, based on initial and 48-hour lab values.
You get a Ranson score on admission and then 2 days after admission to help predict outcomes which can help guide your management as well as give feedback if the current management plan is ineffective. I was having a dandy of a time trying to recall the 11 point scoring system, so I took to the internets for help.
First of all, here is the breakdown of Ranson’s Criteria:
Age in years > 55 years
White blood cell count > 16000 cells/mm3
Blood glucose > 10 mmol/L (> 200 mg/dL)
Serum AST > 250 IU/L
Serum LDH > 350 IU/L
Within 48 hours:
Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
Hematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit (negative base excess) > 4 mEq/L
Sequestration of fluids > 6 L
Interpretation: (each is scored with a point. As a general rule of thumb, anything over 4 is immanently bad news for the patient)
Score 0 to 2 : 2% mortality
Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality
Score 7 to 8 : 100% mortality
So as you can see it’s a lot to take in. I needed a good memory tool! Well thanks to wikipedia, I did:
The mnemonic WALLS FOr CHUB!!
W = WBC
A = Age
L = LDH
L = Liver enzyme (AST)
S = Sugar
F = Fluid requirement
O = pA02
C = Calcium
H = Hematocrit
U = Urea
B = Base deficit
Here’s the kicker, the mnemonic is PERFECT, since it sort-of hints at the ‘typical’ patient that suffers from Acute Pancreatitis (I’ll just let you figure that one out).
Thank you wikipedia for the chuckle and the great memory tool!!