Acute pancreatitis reclassified
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Correspondence to Professor John A Windsor, Department of Surgery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
Science is founded on observation and classification. The taxonomist's task to classify is both dependent and limited by what has been observed and is known. Progress in science is made by classifying seeming disorder, highlighting gaps and contradictions in knowledge and addressing them by experimentation. Classifications are stepping-stones, sign-posting current understanding, promoting hypotheses and enabling comparisons. Such is the iterative nature of science.
Progress has been made in the management of acute pancreatitis, evidenced by a decreasing overall mortality rate. And even though our understanding of the pathophysiology is more complete, specific treatments for acute pancreatitis remain elusive and our classifications have been simplistic. For more than a century we have relied on a binary classification of acute pancreatitis severity.1 Patients had either mild or severe disease, and this approach was enshrined in the original Atlanta Classification 20 years ago. Classification has not kept pace with our understanding of this disease and has hindered studies of potential treatments.2 When misclassification error runs to a quarter or a third of those enrolled, it is little wonder that the clinical trials of potential treatments for acute pancreatitis have been described as a ‘litany of failure’. And maybe we have discarded certain treatments prematurely.2 But the …