The Balthazar scoring system uses CT scanning to stage the severity of disease. Patients with severe acute pancreatitis should undergo a contrast-enhanced CT scan after the first 3 days to distinguish interstitial from necrotizing pancreatitis.
The first table shows grades for acute pancreatitis and the degree of pancreatic necrosis. The second table gives the risk for mortality and complications for each score. The score itself is a combination of the points for the grade of acute pancreatitis combined with the points for the degree of pancreatic necrosis.
| Finding | Points |
|---|
| Grade of acute pancreatitis | | Normal pancreas | 0 | | Pancreatic enlargement | 1 | | Inflammation involving pancreas and peripancreatic fat | 2 | | Single fluid collection or phlegmon | 3 | | Two or more fluid collections or phlegmon | 4 | | Degree of pancreatic necrosis | | No necrosis | 0 | | Necrosis of one-third of the pancreas | 2 | | Necrosis of one-half of the pancreas | 4 | | Necrosis of more than one-half of the pancreas | 6 |
|
| Severity index | Mortality | Complications |
|---|
| 0 to 1 | 0% | 0% | | 2 to 3 | 3% | 8% | | 4 to 6 | 6% | 35% | | 7 to 10 | 17% | 92% |
|