Abstract
ObjectivesThe purpose of this study was to comprehensively assess the heterogeneity of procedures in the diagnostic guidelines for acute pancreatitis and to identify gaps limiting knowledge in diagnosing this disease.MethodsA systematic search of a number of databases was performed to determine the guidelines for the diagnosis of acute pancreatitis in patients with severe pancreatitis. The guidelines for the diagnosis of severe pancreatitis were evaluated by AGREE II. The Measurement Scale of Rate of Agreement (MSRA) was used to assess the guidelines (2015–2020) and extract evidence supporting these recommendations for analysis.ResultsSeven diagnostic guidelines for acute pancreatitis were included. Only the 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis and the Japanese Guidelines for the Management of Acute Pancreatitis: Japanese Guidelines 2015 had a total score of more than 60%, which is worthy of clinical recommendation. The average scores of the Scope and Purpose domain and the Clarity and Expression domain were the highest at 71.62% and 75.59%, respectively, while the average score of the Applicability area was the lowest at 16.67%. The included guidelines were further analyzed to determine the heterogeneity of the diagnosis of acute pancreatitis. The main reasons for the heterogeneity were the citation of low-quality evidence, the presence of far too many indicators for the classification of acute pancreatitis, unclear depictions of the standard, and poorly comprehensive recommendations for the diagnosis of the aetiology in the primary diagnosis of acute pancreatitis, the severity classification, the aetiological diagnosis, and the diagnosis of comorbidities.ConclusionsThe quality of different diagnostic guidelines for severe pancreatitis is uneven. The recommendations are largely based on low-quality evidence, and the guidelines still have much room for improvement to reach a high level of quality. The diagnostic procedures for acute pancreatitis vary widely in different guidelines. There are large differences between them, and resolving the abovementioned reasons would be a very wise choice for guideline developers to revise and upgrade the guidelines in the future.
Highlights
Acute pancreatitis is an inflammatory process that can lead to local and systemic inflammatory reactions
Study design This study was developed through international collaboration and discussion with a panel of experts composed of managers engaged in emergency surgery and patients with severe acute pancreatitis
Of the seven included guides, five guides used three grading systems to rate the level of evidence and the strength of the recommendation (Table 1); 3 [2, 5, 8] adopted the Grading of Recommendations Assessment Development and Evaluation (GRADE) system, one [6] used the APACHE system, and one used the Delphi classification standard [7]
Summary
Acute pancreatitis is an inflammatory process that can lead to local and systemic inflammatory reactions. Most cases of acute pancreatitis are mild, approximately 20–30% of patients will develop severe pancreatitis with pancreatic tissue necrosis and/or multiple organ failure. If the patient had infectious necrosis but no organ failure, the mortality rate was 1.4% [2]. A standardized diagnosis of acute pancreatitis is essential for the early treatment of the disease. Many academic organizations and experts in related fields have developed guidelines for the diagnosis of acute pancreatitis [2,3,4,5,6,7,8]. The diagnosis of inflammation should follow proper diagnostic procedures to ensure that the diagnosis of acute pancreatitis is logical and reasonable [3]. The current diagnostic guidelines for acute pancreatitis vary widely in terms of the recommendations and corresponding evidence supporting acute pancreatitis, which limits their clinical use
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