Sa1354 Acute Pancreatitis Associated With Acute Hepatitis E: A Series of 16 Patients

Abstract

Introduction: Acute pancreatitis (AP) is a common medical emergency with an estimated mortality rate between 3 to 5%. The aim of this study is to investigate the incidence and mortality of Emergency Department (ED) visits in the United States attributed primarily to AP using a population-based cohort. As a secondary objective, we quantify predictors of admission and mortality. Materials and Methods: The Nationwide Emergency Department Sample (NEDS), a component database of the Healthcare Cost and Utilization Project, was used for this study. NEDS is the largest all-payer ED database in the U.S. and contains between 25-30 million records for ED visits for over 950 hospitals and approximates a 20percent stratified sample of U.S. hospital-based EDs. All ED visits between January 1, 2006 and December 31, 2009 with a primary diagnosis of AP (ICD-9-CM 577.0) were extracted. All estimates were projected to national levels using discharge weight variables. Multivariable analyses adjusted for clustering were fitted for prediction of admission and mortality. Results: Between 2006 and 2009, a weighted sample of 1,224,121 patient visits with AP as the primary diagnosis was captured in the NEDS. Of those, (75.4%) patient visits resulted in admission, and 9081 (0.7%) died during hospital stay. The incidence of AP ED visits increased from 9.9 to 10.6 per 10,000 person years between 2006 and 2009, respectively. Patients were more likely to be admitted if older (OR=1.01, p ,0.001), if sicker (CCI≥3; OR=7.70, p,0.001), or if presenting at a metropolitan teaching vs. non-teaching hospital (OR=1.13, p,0.0001). Patients were less likely to be admitted if covered with Medicaid vs. Medicare (OR=0.90, p,0.001), or if admitted during the weekend vs. weekday (OR=0.97, p=0.027). Patients were more likely to die if older (OR=1.05, p,0.0001), or if sicker (CCI≥3; OR=1.30, p,0.0001). They were less likely to die if covered with private insurance vs. Medicare (OR=0.71, p,0.001). Conclusions: ED visits for AP represents a significant burden on American health care. However, our analysis demonstrates that in-hospital mortality from this condition is lower than previously reported. Furthermore, significant disparities exist in patients presenting with AP with regard to admission and mortality rates. Further investigations are needed to assess and correct these disparities.