🩻 CT Severity Index (CTSI, Balthazar)
UseAssess prognosis in acute pancreatitis from imaging.
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SourceBalthazar EJ, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋pancreatitisOpen scene pack →Matching pathway
🧭acute_pancOpen pathway →Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
Assess contrast-enhanced CT > 72 h after onset to avoid underestimating necrosis.
When to use
Assess prognosis in acute pancreatitis from imaging.
How it works
CTSI = Balthazar grade (A–E = 0–4) + necrosis extent (0/2/4/6), total 0–10. 0–3 mild, 4–6 moderate, 7–10 severe.
Key points
- Assess contrast-enhanced CT > 72 h after onset to avoid underestimating necrosis.
- Higher scores carry higher complication and mortality rates.
- The modified CTSI (Mortele) adds extrapancreatic complications.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Balthazar CT grade | C (2): pancreatic + peripancreatic inflammation |
|---|---|
| Extent of pancreatic necrosis | ≤ 30% (2) |
→CTSI4/10
- Band：4 → Moderate (0–3 mild, 4–6 moderate, 7–10 severe); higher scores carry higher complication and mortality rates
- Timing：Contrast-enhanced CT is best assessed > 72 h after symptom onset (earlier underestimates necrosis); necrosis requires contrast-enhanced CT (reduced enhancement)
- Note：The modified CTSI (Mortele) simplifies necrosis grading and adds extrapancreatic complications (+2); this tool uses the classic Balthazar CTSI (grade 0–4 + necrosis 0/2/4/6)
| Balthazar CT grade | A (0): normal pancreas |
|---|---|
| Extent of pancreatic necrosis | No necrosis (0) |
→CTSI0/10
- Band：0 → Mild (0–3 mild, 4–6 moderate, 7–10 severe); higher scores carry higher complication and mortality rates
- Timing：Contrast-enhanced CT is best assessed > 72 h after symptom onset (earlier underestimates necrosis); necrosis requires contrast-enhanced CT (reduced enhancement)
- Note：The modified CTSI (Mortele) simplifies necrosis grading and adds extrapancreatic complications (+2); this tool uses the classic Balthazar CTSI (grade 0–4 + necrosis 0/2/4/6)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using CT Severity Index (CTSI, Balthazar)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does CT Severity Index (CTSI, Balthazar) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is CT Severity Index (CTSI, Balthazar) calculated in practice? Can you show a worked example?
- Inputs: Balthazar CT grade C (2): pancreatic + peripancreatic inflammation, Extent of pancreatic necrosis ≤ 30% (2) → Result: CTSI 4 /10（Band: 4 → Moderate (0–3 mild, 4–6 moderate, 7–10 severe); higher scores carry higher complication and mortality rates, Timing: Contrast-enhanced CT is best assessed > 72 h after symptom onset (earlier underestimates necrosis); necrosis requires contrast-enhanced CT (reduced enhancement), Note: The modified CTSI (Mortele) simplifies necrosis grading and adds extrapancreatic complications (+2); this tool uses the classic Balthazar CTSI (grade 0–4 + necrosis 0/2/4/6)） Inputs: Balthazar CT grade A (0): normal pancreas, Extent of pancreatic necrosis No necrosis (0) → Result: CTSI 0 /10（Band: 0 → Mild (0–3 mild, 4–6 moderate, 7–10 severe); higher scores carry higher complication and mortality rates, Timing: Contrast-enhanced CT is best assessed > 72 h after symptom onset (earlier underestimates necrosis); necrosis requires contrast-enhanced CT (reduced enhancement), Note: The modified CTSI (Mortele) simplifies necrosis grading and adds extrapancreatic complications (+2); this tool uses the classic Balthazar CTSI (grade 0–4 + necrosis 0/2/4/6)）