S96 Overutilization of Contrast-enhanced CT (CECT) Abdomen in the Diagnosis of Acute Pancreatitis (AP) in the Emergency Department (ED)

Abstract

Introduction: AP is an inflammatory disorder of the pancreas which is one of the leading causes of gastrointestinal disorder admissions in the United States (US). As incidence of AP increases, so does the demand for effective means of diagnosis. According to revised Atlanta classification of 2012, typical abdominal pain in the epigastrium or left upper quadrant along with an elevated lipase level greater than 3-5 times the upper limit of normal is enough to diagnose AP. Contrast-enhanced CT (CECT) should only be obtained in cases of atypical presentation or failure to improve in 48-72 hours. However, availability of CECT has led to overutilization of its use in the diagnosis of AP, which can lead to delay in management, unnecessary radiation, and increased cost burden. Here we report a one-year data from a single medical center to assess utilization of CECT in the emergency department (ED) in the diagnosis of AP and if it changed management, length of stay (LOS), or outcomes. Methods: Data from 2018 to 2019 for all patients diagnosed with AP in the ED were analyzed. In total, 140 patients, 68 males and 72 females were analyzed. We evaluated lipase levels, CECT findings, LOS, and outcome. We used t-test to compare average means. Results: The most common etiology causing AP was alcohol abuse (37%), idiopathic (28%), gallstones (22%), followed by 8 cases due to drugs, 6 due to hypertriglyceridemia, 2 due to hypercalcemia, and 1 due to a pancreatic mass. All patients had presented with epigastric pain. Average lipase among all patients was 1727 U/L with a median of 530 U/L. CECT imaging was performed in 105 patients (75%). Among those who underwent CECT abdomen, 80 cases (76%) had positive finding for AP, while remaining 25 (24%) did not. Average lipase values were significantly elevated (2290 U/L vs 1732 U/L) among those who did not undergo CECT abdomen compared to those who did (P-value < 0.02). There were no statistical significance in both groups as far as management, LOS, hospitalization course, or outcomes. Conclusion: The purpose of this study was to assess how frequently was CECT used in the initial diagnosis in the ED setting and if it was helpful in changing management. Our results indicated that routine use of imaging in the diagnosis of AP is not necessary and has no impact on management and outcome. However, it can lead to increased radiation exposure and cost burden. Therefore, we recommend judicious use of CECT and recommend against routine utilization in the initial diagnosis of AP.