S0060 Characterization of Diagnostic Patterns of Chronic Pancreatitis Within a Large Health Management Organization

Abstract

INTRODUCTION: Chronic pancreatitis (CP) is an irreversible and progressive fibro-inflammatory disease of the pancreas causing pain and/or loss of exocrine/endocrine function. It is typically diagnosed with a combination of clinical and imaging criteria including atrophy, ductal dilatation, multiple parenchymal and intraductal calcifications. One of the main challenges in making a diagnosis of CP is the lack of universally agreed gold standard diagnostic criteria. To better understand the diagnostic patterns of this chronic, often disabling illness, we performed a retrospective analysis of 215 patients with CP treated at 9 hospitals of MedStar Health. METHODS: Using ICD 10 codes, we retrieved charts of patients presenting to acute care sites within the MedStar Health system between March 2015 and June 2019. These included emergency room visits and inpatient admissions. The following 7 variables pertaining to diagnosis of CP were manually extracted: 1. How was CP diagnosed? 2. Who made the diagnosis? 3. Demographics including sex, age 4. Length of stay 5. Was a GI consult obtained? 6. Location of care (Tertiary care vs. Non-tertiary care hospital) 7. Presumed etiology. Statistical analysis was performed by ANOVA analysis using GraphPad PRISM for Mac OS (Version 8). RESULTS: We found 215 encounters eligible for retrospective chart review. Average length of stay (in days) was longest when a gastroenterologist made the diagnosis (7.48), followed by the internist (2.02), or when a prior diagnosis was known (1.35). When a gastroenterologist was consulted, the chance of making an accurate diagnosis of CP was highest (53%) vs. when they weren’t consulted (20%). Most patients received a diagnosis of CP at a non-tertiary care center. The specialist making the diagnosis significantly changed the probability of accurate diagnosis (P < 0.0001) by clinical and imaging criteria. CONCLUSION: Most patients with CP are diagnosed at non-tertiary centers within the MedStar Health System. Most of these patients are given a diagnosis based on a prior diagnosis of CP. Accuracy of diagnosis significantly improved when a gastroenterologist was consulted. Non-tertiary centers most commonly made a diagnosis of CP based on inappropriate clinical and imaging criteria. These represent avenues for targeted interventions to standardize the diagnosis of CP across a large health management organization.Table 1.: TablesFigure 1.: Retrospective study design.Figure 2.: Graphs.