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CAPER Acute Pancreatitis Registry

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Demographics
Record ID

__________________________________

Patient initials

__________________________________

Age

__________________________________
(Age in years)

Gender

Female
Male

Race

White
African-American
Hispanic
Asian-Indian
Asian-Oriental
Other

BMI

__________________________________
(Body mass index)

Charlson index

__________________________________
(Charlson comorbidity index)

Smoking

Never
Current
Past
(smoking history)

Preexisting DM

Yes
No
(Preexisting diabetes melitus)

DM type

Type 1
Type 2
(Type of preexisting diabetes melitus)

NSAIDS use the last 7 days

Yes
No

Statin use

Yes
No

AP etiology

History of AP

Biliary
Alcoholic
Idiopathic
Hypertriglyceridemic
Post-ERCP
Other
(Etiology of acute pancreatitis)
First episode
Recurrent episode

Number of prior episodes

__________________________________
(Number of prior acute pancreatitis episodes)

Pain onset

__________________________________
(Date and time that pain started)

Initial hospital admission

__________________________________
(Date and time of initial hospital admission)

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Transfer

Yes
No
(Patient transferred from an outside hospital)

Admission to referral center

__________________________________
(Date and time of admission to the referral
center)

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Early markers

CAPER Acute Pancreatitis Registry

Page 3 of 8

BUN adm (mg/dL)

__________________________________
(blood urea nitrogen on initial hospital
admission)

HCT adm (%)

__________________________________
(hematocrit on initial hospital admission)

CRP adm (mg/L)

__________________________________
(C-reactive protein on initial hospital admission)

BUN 24 hours (mg/dL)

__________________________________
(blood urea nitrogen at 24 hours from initial
hospital admission)

HCT 24 hours (%)

__________________________________
(hematocrit 24 hours from initial hospital
admission)

CRP 24 hours (mg/L)

__________________________________
(C-reactive protein at 24 hours from initial
hospital admission)

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Early management

CAPER Acute Pancreatitis Registry

Page 4 of 8

IVF in the first 24 hours

__________________________________
(intravenous fluids administered during the first
24 hours from admission (only direct admissions))

ICU admission

Yes
No
(intensive care unit admission)

Date and time

__________________________________
(date and time of ICU admission)

Reason

__________________________________
(reason for ICU admission)

Death while in ICU

Yes
No
(patient died while in ICU)

ICU LOS (days)

__________________________________
(length of ICU stay in days)

Nutritional support

No
Enteral nutrition- NG
Enteral nutrition- NJ
TPN
(nutritional support required)

Date and time

__________________________________
(date and time nutritional support initiated)

How quickly escalated?

slow
moderate
rapid
(How quickly nutritional support escalated)

Early intervention

no
open
pcd
endoscopic
(early intervention within 2 weeks from admission)

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CAPER Acute Pancreatitis Registry

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Outcomes
Organ Failure

Yes
No
(Organ failure based on Marshall score)

Modified Marshall score

__________________________________

Date and time of OF

__________________________________
(Date and time of Organ Failure development)

System that failed

cardiovascular
respiratory
renal
(Organ system that failed)

Transient OF

Yes
No
(Transient Organ Failure (< 48 hours))

Persistent OF

Yes
No
(Persistent Organ Failure development (>=48
hours))

Single OF

Yes
No
(Single Organ Failure development )

Multiple OF

Yes
No
(Multiple Organ Failure develoment)

Contrast-enhanced CT

Yes
No
(Contrast-enhanced computerized tomography)

Pancreatic Necrosis

Yes
No
(Pancreatic necrosis on the CT scan)

Date that Pancreatic Necrosis identified

__________________________________

Infected Necrosis

Yes
No
(Infected Pancreatic Necrosis)

Walled-off Pancreatic Necrosis

Yes
No

Symptomatic local complications

Yes
No
((Peri)pancreatic fluid collections with
leukocytosis and/or fever and/or prolonged pain)

Days that parenteral narcotics required

__________________________________
(Number of days that parenteral narcotics were
required)

Total Hospital LOS (days)

__________________________________
(Total Hospital Lenght of Stay in Days (n=in
hospital death))

Mortality in hospital or 10 days after discarge

no
yes/related to AP
yes/unrelatd to AP-accident
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Date of death

__________________________________

Revised Atlanta Classification

mild AP
moderately severe AP
severe AP

Determinant-based classification

mild AP
moderate AP
severe AP
critical

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Delayed drainage/debridement

CAPER Acute Pancreatitis Registry

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Delayed drainage/debridement

open surgery
laparoscopic surgery
percutaneous drainage catheter
endoscopy
(Delayed intervention for drainage/debridement of
the necroma)

Date of 1st intervention

__________________________________

Date of 2nd intervention

__________________________________

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CAPER Acute Pancreatitis Registry

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Follow up
Follow-up between 30-90 days

Yes
No

Date of contact with the patient

__________________________________

Number of ER visits related to AP since discharge

__________________________________

Number of hospitalizations related to AP since

discharge

__________________________________

New onset diabetes

Yes
No

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