Review for 10.1186/s12876-021-01706-8 (2021)

Reviewer’s report
Title: 
Clinical characteristics of acute pancreatitis in children: a single-center
experience in Western China
Version: 
0 
Date: 
27 Dec 2020
Reviewer: 
Ujjal Poddar
Reviewer's report:
Major comments: 
In this retrospective study authors have reported 130 case of acute pancreatitis in
children with no novel information. The following issues needs to be addressed
to make it more comprehensive. 
1. Etiology of acute pancreatitis: Idiopathic is not an etiology, when no known
cause is found we label them as idiopathic. Hence, the statement should be
modified as, gallstone is the commonest causes and in a significant proportion
(28.5%) of cases no cause could be found.
2. Systemic illness such as sepsis, hemolytic uremic syndrome, autoimmune
disorders like SLE, HSP, IBD etc. is one of the common etiology of acute
pancreatitis in children (Abu-El Haija M et al. JPGN 2018;66:159-76). It is
surprising that none of the cases had systemic illness as a cause. Have they been
look for?
3. The main driving force behind the progression of acute pancreatitis to
recurrent acute and chronic pancreatitis is genetic predisposition (Poddar et al,
Dig Liv Dis 2015;47:709-14. Abu-El-Hajia, et al. Pancreatology 2019;19:535-
40). The major drawback of this study is that genetic predisposition was not
looked for. It needs to be discussed properly with relevant citation (as mentioned
above) in the discussion.
4. INSPPIRE definition of acute recurrent pancreatitis is different than what has
been mentioned in this article (Morinville VD, et al. Definition of Pediatric
Pancreatitis….. JPGN 2012; 55: 261-5). 
5. Instead of low age and high age, the appropriate terminology should be
younger and older children (<10 years and ≥10 years).
6. Since it was a retrospective study, the method of data retrieval needs to be
clarified. Was it audit of electronic database or retrieval of manual hospital
records? Similarly, follow up protocol needs to be elaborated.
7. Since follow up data was recorded on phone, how certainly the diagnosis of
acute recurrent pancreatitis was made?
8. The comparison group (adults with acute pancreatitis) does not seem to be
homogenous. The common causes of AP in adults are biliary and alcohol but, in
this cohort, alcohol was responsible for just 9% of cases and surprisingly
hyperlipidemia which is a rare cause of AP, was responsible in 34% of cases.
The etiological spectrum in adult cohort needs to be substantiated with proper
literature support. If this kind of spectrum is unique then that has to be discussed.
9. Treatment part is confusing and needs to be simplified. Out of 130, 123 cured
and discharged, 7 improved or discharged for further treatment, 8 were treated
with cholecystectomy and 14 had pseudocyst of them 4 required drainage.
Altogether it becomes 152 cases!!!! This part needs to be simplified.
10. Data presentation should be uniform. Median and IQR were used in text and
mean +/-SD in table.
11. It is surprising to see only 18 cases had either necrosis or fluid collections out
of 34 cases of moderately severe and severe pancreatitis. What was the basis of
putting a label of moderately severe/severe in the remaining 16 cases needs to be
clarified?
12. For comparison of severity of pancreatitis between children and adults,
moderately severe plus severe together should be clubbed together (as the
individual numbers are small) and then only statistical significance can be
documented and not individually (moderate or severe).
13. As the authors claimed that they have used modified Atlanta classification to
assess severity of acute pancreatitis, it should be mentioned the proportion of
cases with ANC, APFC and WON. Pseudocyst was documented in 14 but there
is no mention about WON. What was the overall follow up period of the cohort
and what was the median size of the fluid collections?
14. Table 1 is irrelevant as most of the parameters are not significantly different.
There is no point in comparing age between adults and children and same is true
for etiology. Other parameters such as inflammatory markers and amylase/lipase
levels were not expected to be different. Only difference in severity should be
mentioned in the text.
15. Table 2: irrelevant and should be deleted. Findings can be mentioned in the
text as nothing was significant.
16. Discussion should be concise and related to the findings of the present study.
Hypothetical discussion carries no meaning. There was no difference in mortality
and time elapsed between onset of symptoms and hospitalization between adults
and children in this study (Table 1). However, authors have discussed that
increased severity in adults as compared to children was due to delayed
hospitalization and increased mortality in adults due to difference in etiology etc.
Please revamp the discussion and it should be related to this study only.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
No