# Comparison of the Prognostic Performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and Emergency Room Assessment of Acute Pancreatitis (ERAP) Scores in Acute Pancreatitis

## TL;DR

This study compares two scoring systems for predicting severe acute pancreatitis and finds that ERAP may be slightly better than BISAP, though the difference is not statistically significant.

## Contribution

The study evaluates and compares the ERAP and BISAP scores in an Indian emergency setting for predicting severe acute pancreatitis outcomes.

## Key findings

- ERAP showed higher AUC than BISAP for predicting severe AP and mortality, but the difference was not statistically significant.
- Both ERAP and BISAP had similar AUC for predicting organ failure.
- Alcohol was the main cause of acute pancreatitis in the studied population.

## Abstract

Background: Early identification of severe acute pancreatitis (AP) is crucial for timely intervention, optimal resource utilization, and better outcomes. Although several scoring systems exist, their accuracy and applicability in emergency settings remain uncertain. This study evaluated the prognostic accuracy of the Emergency Room Assessment of Acute Pancreatitis (ERAP) score and compared it with the Bedside Index for Severity in Acute Pancreatitis (BISAP) score for predicting severe AP, mortality, and organ failure in an Indian population and emergency settings.

Materials and methods: We conducted a prospective observational study in the Department of Trauma and Emergency at All India Institute of Medical Sciences (AIIMS), Nagpur, between December 2023 and January 2025. Patients over 18 years old diagnosed with AP using the Revised Atlanta Criteria were included. Admission data were used to calculate ERAP and BISAP scores. Predictive accuracy for severe AP, mortality, and organ failure was assessed via the area under the curve (AUC).

Results: Among 165 patients (mean age 37.9 ± 12.1 years), alcohol (139 (84.2%)) was the predominant cause for AP. Severe AP occurred in 31 (18.8%). The ERAP and BISAP scores showed AUCs of 0.852 vs. 0.784 for severe AP, 0.853 vs. 0.778 for mortality, and 0.843 vs. 0.844 for any organ failure, with an optimal cutoff ≥ 2 for both. ERAP demonstrated numerically higher prognostic accuracy than BISAP for severe AP (P = 0.1190) and mortality (P = 0.2829), but those were not statistically significant.

Conclusions: ERAP showed slightly higher but statistically insignificant predictive accuracy than BISAP, suggesting ERAP as an alternative for early risk stratification in emergency settings.