Variant 1: Suspected acute pancreatitis. First time presentation. Epigastric pain and increased amylase and lipase. Less than 48 to 72 hours after symptom onset. Initial imaging.
Variant 2: Suspected acute pancreatitis. Initial presentation with atypical signs and symptoms; including equivocal amylase and lipase values (possibly confounded by acute kidney injury or chronic kidney disease) and when diagnoses other than pancreatitis may be possible (bowel perforation, bowel ischemia, etc.). Initial imaging.
Variant 3: Acute pancreatitis. Critically ill, systemic inflammatory response syndrome (SIRS), severe clinical scores (eg, Acute Physiology, Age, and Chronic Health Evaluation [APACHE]-II, Bedside Index for Severity in AP [BISAP], or Marshall). Greater than 48 to 72 hours after onset of symptoms.
Variant 4: Acute pancreatitis. Continued SIRS, severe clinical scores, leukocytosis, and fever. Greater than 7 to 21 days after onset of symptoms.
Variant 5: Known necrotizing pancreatitis. Significant deterioration in clinical status, including abrupt decrease in hemoglobin or hematocrit, hypotension, tachycardia, tachypnea, abrupt change in fever curve, or increase in white blood cells.
Variant 6: Acute pancreatitis. Known pancreatic or peripancreatic fluid collections with continued abdominal pain, early satiety, nausea, vomiting, or signs of infection. Greater than 4 weeks after symptom onset.
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at