From the Guidelines
The Bush/Jacoby classification should not be used in clinical practice due to its lack of external validation, variable correlation with clinical symptoms, and inability to predict treatment outcomes or prognosis. This classification system, along with other historic and minor systems, has been deemed insufficient for guiding clinical decisions, as noted in the World Endometriosis Society consensus on the classification of endometriosis 1. The key points to consider when evaluating classification systems for endometriosis include their ability to:
- Correlate with clinical symptoms
- Predict treatment outcomes
- Provide prognostic information
- Have gained wide acceptance in the medical community Given that the Bush/Jacoby classification falls short in these areas, it is not recommended for use in clinical practice, according to the consensus published in Human Reproduction Update in 2017 1. Instead, clinicians should rely on more widely accepted and validated classification systems that can better inform treatment decisions and improve patient outcomes. Some of the limitations of the Bush/Jacoby classification include:
- Lack of external validation
- Variable correlation with clinical symptoms
- Inability to predict treatment outcomes or prognosis
- Limited acceptance in the medical community These limitations highlight the need for a more robust and reliable classification system for endometriosis, as emphasized by the World Endometriosis Society consensus 1.
From the Research
Bush/Jacoby Classification
The Bush/Jacoby classification is not directly mentioned in the provided studies. However, the studies discuss various classification systems for acute pancreatitis, including:
- Revised Atlanta classification 2, 3
- Determinant-based classification (DBC) 4, 3
- Bedside Index of Severity in Acute Pancreatitis (BISAP) 5, 4
- Acute Physiology and Chronic Health Evaluation (APACHE) II 5
- Harmless AP Score (HAPS) 4
- Japanese Severity Score (JSS) 4
- Symptoms Nutrition Necrosis Antibiotics and Pain (SNNAP) 4
- PANC 3 4
- Original Atlanta classification (OAC) 4, 3
Classification Systems
These classification systems aim to stratify patients with acute pancreatitis into coherent risk groups. The studies compare the effectiveness of these systems in predicting outcomes, such as:
- Need for surgery 4, 3
- Intensive care unit (ICU) admission 4, 3
- Readmission within 30 days 4
- Length of hospital stay 4, 3
- In-hospital mortality 3
Key Findings
The studies suggest that:
- The revised Atlanta classification and DBC system perform equally well for classification of disease severity in acute pancreatitis 3
- The DBC system identifies patients with the most severe disease 3
- Early and aggressive fluid resuscitation and early enteral nutrition are associated with lower rates of mortality and infectious complications 5
- The underlying etiology of acute pancreatitis should be sought in all patients, and risk-reduction strategies should be used during and after hospitalization 5, 2