CT Scan Imaging in Diagnosing Acute Uncomplicated Pancreatitis: Usefulness versus Cost

Abstract

Introduction: Guidelines indicate that routine use of imaging is unwarranted in patients with acute uncomplicated pancreatitis (AUP) that present with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease. The objective of this study is to assess the overutilization and associated cost of computed tomography (CT) imaging in patients with acute uncomplicated pancreatitis that meet two of the three diagnostic criteria. Methods: In this Institutional Review Board-approved retrospective single-center study, we identified all adult patients with acute pancreatitis (AP) from January 2012 through October 2017. Patients were initially identified via ICD-9 code for acute pancreatitis (577.0) and ICD-10 codes for different etiological AP (K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria (presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal) prior to any imaging ordered. Ranson criteria and BISAP scores on presentation were calculated and only those that met scores less than or equal to 2 for both were included, suggesting AUP. The utilization and cost of imaging in these patients were recorded. Results: Between January 2012 and October 2017, 1305 patients were admitted with AP, and 405 patients (31%) met our inclusion criteria for AUP (201 males, 204 females; mean age 49, range 18-98). Of those, 210 patients (51.85%) underwent computed tomography. One patient (0.47%) had evidence of complication (pancreatic necrosis). The average cost of CT scan imaging was $4,510 with a total cost of $947,056 spent on overutilized CT imaging. Median length of hospitalization among those that received CT imaging and those did not were the same at 3 days. Conclusion: In patients with acute pancreatitis, diagnosed clinically and biochemically, computed tomography rarely demonstrates pancreatitis related complications when Ranson and BISAP scores are less or equal to 2. Reducing the overuse of diagnostic CT imaging in AUP will limit excess healthcare expenditure and decrease radiation exposure to patients, especially in younger individuals with risk to suffer from potential delayed deleterious effects. Efforts should be made for evidence based practice that discourages overutilization and increased awareness in radiation risk through the Image Wisely campaign by ACR/RSNA.