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In Reply: Dr Piwinski has correctly stated the limitation of Ranson's criteria in the assessment of severity of acute pancreatitis and believes that the prognostic system proposed by Rabeneck et al¹ is more useful. In our review, we cited the scoring systems of Ranson, Imrie, APACHE II, and Balthazar because these have been validated and extensively used in the literature. Space constraints for a short review did not permit us to discuss in detail the acknowledged imperfections and shortcomings of all of these systems, although we did note that Ranson's criteria system has the disadvantage of a 48-hour delay for completion.

Although we agree with the general sentiments expressed by Dr Piwinski and believe that systems used to predict severity can and should be improved, it is our opinion that the system proposed by Rabeneck et al has not been validated in any prospective study and, therefore, is not a . . . [Full Text of this Article]

Vege Santhi Swaroop, MD
vege.santhi@mayo.edu

Suresh T. Chari, MD; Jonathan E. Clain, MD
Department of Internal Medicine
Mayo Clinic
Rochester, Minn

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