S3077 Acute Pancreatitis Without Early Imaging Changes Has Similar Outcomes to Those With Early Changes

Abstract

INTRODUCTION: Increased use of abdominal computed tomography (CT) in the emergency department (ED) has led to a diagnostic dilemma where patients present with abdominal pain and lipase levels three times the upper limit of normal (ULN) while abdominal imaging may not support a diagnosis of acute pancreatitis (AP). This study seeks to determine whether early imaging findings are associated with change in clinical outcomes in AP patients. METHODS: The study is a single-center, retrospective cohort study with patients from 1/1/2016 to 12/31/2018 presenting to the ED and tested for serum lipase levels (N = 1464). Those with serum lipase of three times ULN (N = 209) and with CT imaging of the abdomen and pelvis with contrast performed in the ED were included in the cohort (N = 93). All charts were reviewed for repeat CT imaging, magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) during admission, bedside index for severity in AP (BISAP) score criteria, intensive care unit (ICU) admission, hospital length of stay (LOS), in-hospital mortality and hospital disposition. Outcome measurements consisted of RR of death, ICU admission, BISAP score >=2, BISAP >=3, inpatient ERCP and median length of hospital stay for patients with CT changes suggesting AP at ED presentation versus those patients with CT not notable for changes of AP. RESULTS: CT findings consistent with AP were associated with a RR for ICU admission of 1.47 [CI: 0.41-5.33, P = 0.55] , RR of 3.79 [CI:0.48-30.20, P = 0.21] for repeat inpatient CT imaging, RR of 0.95 [CI:0.48-2.33, P = 0.89] for MRCP, RR of 1.05 [CI:0.42-2.65, P = 0.91] for ERCP, RR of 0.32 [CI:0.03-3.36, P = 0.34] for death, RR of 0.63 [CI:0.09-4.29, P = 0.64] for non-home disposition, RR of 0.32 [CI:0.03-3.35, P = 0.34] for BISAP >=3, RR of 1.26 [CI:0.52-3.07, P = 0.61) for BISAP >=2. Difference in mean LOS for CT positive AP was 1.73 [CI:0.21-3.67, P = 0.08] 4.7 days versus 2.97 days in CT negative AP. CONCLUSION: Ninety-three out of 209 (44%) patients with lipase levels three times the ULN underwent CT imaging during ED assessment. Relative risk of ICU admission, difference in mean hospital LOS, risk of BISAP≥2 and BISAP≥3, risk of mortality and non-home disposition rate were all statically non-significant. These findings suggest that patients with early CT imaging not showing changes of AP have an unchanged clinical course. Therefore, they should be treated similarly as those with CT imaging displaying AP.