Abstract
BackgroundSingle-center studies suggest an increasing incidence of acute pancreatitis (AP) in children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States.MethodsWe used the Healthcare Cost and Utilization Project Kids’ Inpatient Database, Agency for Healthcare Research and Quality for the years 2000 to 2009. Extracted data were weighted to generate national-level estimates. We used the Cochrane-Armitage test to analyze trends; cohort-matching to evaluate the association of AP and in-hospital mortality, length of stay, and charges; and multivariable logistic regression to test the association of AP and demographics and comorbid conditions.ResultsWe identified 55,012 cases of AP in hospitalized children (1–20 years of age). The incidence of AP increased from 23.1 to 34.9 (cases per 10,000 hospitalizations per year; P<0.001) and for all-diagnoses 38.7 to 61.1 (P<0.001). There was an increasing trend in the incidence of both primary and all-diagnoses of AP (P<0.001). In-hospital mortality decreased (13.1 to 7.6 per 1,000 cases, P<0.001), median length of stay decreased (5 to 4 days, P<0.001), and median charges increased ($14,956 to $22,663, P<0.001). Children with AP compared to those without the disease had lower in-hospital mortality (adjusted odds ratio, aOR 0.86, 95% CI, 0.78–0.95), longer lengths of stay (aOR 2.42, 95% CI, 2.40–2.46), and higher charges (aOR 1.62, 95% CI, 1.59–1.65). AP was more likely to occur in children older than 5 years of age (aORs 2.81 to 5.25 for each 5-year age interval). Hepatobiliary disease was the comorbid condition with the greatest association with AP.ConclusionsThese results demonstrate a rising incidence of AP in hospitalized children. Despite improvements in mortality and length of stay, hospitalized children with AP have significant morbidity.
Highlights
Acute pancreatitis (AP) is defined as reversible inflammation of the pancreatic parenchyma and is characterized by the presence of interstitial edema, acute inflammatory cell infiltrate, and varying degrees of cellular apoptosis, necrosis and hemorrhage [1]
The INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) consortium recently operationally defined the diagnosis of acute pancreatitis (AP) as requiring two of the following: (i) abdominal pain compatible with AP, (ii) serum amylase or lipase levels greater or equal to three times the upper limits of normal, and (iii) imaging findings consistent with AP [2]
Nydegger and colleagues retrospectively evaluated cases at a large pediatric referral and trauma center (The Royal Children’s Hospital) in Melbourne, Australia from 1993 through 2002 [6]. They found an increase in the annual incidence of pancreatitis from 24.662.3 cases per year per 100,000 children for the initial 5-year period to 31.266.0 for the last 5-year period of the study. This change in incidence of AP was determined to be due to primarily an increase in the number of cases of AP associated with systemic diseases and those with an unidentified etiology
Summary
Acute pancreatitis (AP) is defined as reversible inflammation of the pancreatic parenchyma and is characterized by the presence of interstitial edema, acute inflammatory cell infiltrate, and varying degrees of cellular apoptosis, necrosis and hemorrhage [1]. Nydegger and colleagues retrospectively evaluated cases at a large pediatric referral and trauma center (The Royal Children’s Hospital) in Melbourne, Australia from 1993 through 2002 [6]. They found an increase in the annual incidence of pancreatitis from 24.662.3 cases per year per 100,000 children for the initial 5-year period to 31.266.0 for the last 5-year period of the study. Morinville and colleagues reviewed cases of AP admitted to the Children’s Hospital of Pittsburgh from 1993 to 2004 [5] During this period of time, the incidence of first time admission for AP increased over 5-fold from 2.4 to 13.2 per 100,000 children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States
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