S0073 Over-Utilization of Early Cross-Sectional Imaging in the Diagnosis of Acute Pancreatitis

Abstract

INTRODUCTION: Acute pancreatitis (AP) accounts for $2.6 billion in costs annually. The American College of Gastroenterology recommends that cross-sectional imaging in acute pancreatitis should be reserved for patients in whom the diagnosis is unclear, who fail to clinically improve within 48–72 hours after admission, or to evaluate for complications. We aim to assess the use of early cross-sectional imaging (within 72 hours of admission) among those admitted with AP. METHODS: This was a retrospective study of patients who presented at a tertiary care center emergency department with acute pancreatitis from January 1, 2009 to December 31, 2019. Patients were identified by diagnosis codes for acute pancreatitis and were included if they presented with abdominal pain and had a lipase level greater than or equal to three times the upper limit of normal. Exclusion criteria included age less than 18 years, pregnancy, or abdominal pain due to trauma. Variables that were not available from the center’s database were manually extracted from electronic medical records. RESULTS: Over the 11-year study period, 993 patients met the study inclusion criteria. Approximately half of the patients were female (49.3%) and overall average age was 53.8 years (Table 1). Average Charlson comorbidity index was 3.29. The most common etiology of AP was biliary followed by alcohol. Among this cohort, 60.9% of patients had early cross-sectional imaging. Among those who underwent imaging, 97.2% of the radiology readings revealed either normal (33.6%) or uncomplicated acute pancreatitis (63.6%) (Figure 1). Patients who received imaging were older (55 vs. 51 years, P < 0.01), had higher mean lipase levels (4781 vs. 3490, P = 0.02), and higher mean BISAP scores (1.16 vs. 1.01, P = 0.03). CONCLUSION: The majority of patients who met non-imaging diagnostic criteria for AP received early cross-sectional imaging. Over 97% of the imaging demonstrated normal or uncomplicated acute pancreatitis which does not affect clinical management in the first 5–7 days of presentation. Efforts should be made at the institutional level to reduce unnecessary cross-sectional imaging in patients admitted with AP in order to limit radiation exposure for patients and reduce health care costs.Table 1.: Demographics and clinical characteristics of patients with acute pancreatitisFigure 1.: Results of imaging performed in the first 72 hours of presentation.