WP5.2 - Acute Pancreatitis: challenging the relevance of the modified Glasgow score and bridging the gap to optimise management

Abstract

Abstract Aims Acute pancreatitis is a frequently encountered emergency surgical presentation, with an incidence of 56 cases per 100,000 per year. 10%- 20% of patients develop a rapidly progressive inflammatory response with an overall mortality rate of 5%. Deciding the need for intervention during pancreatitis is variable. Predicting severity is challenging and multifactorial. Scoring systems aid in standardisation of treatment, however they do not factor in the evolving knowledge on factors that predict mortality in severe acute pancreatitis. The aim of this audit was to identify any gaps in optimising the management of acute pancreatitis. Methods Prospective data was collected between January 2023 – May 2023 and analysed against current NICE and UK working Party on Acute Pancreatitis guidelines. Results 41 patients were identified with a median age of 60 (53.7% male, 46.3% female). No cases required admission to intensive care. Gallstones (56.2%) and alcohol (19.6%) were identified as leading causes. Key gaps in management were identified: 12.2% of patients were scored via the modified Glasgow score, 24.4% received antibiotics without a clinical indication, 34% received aggressive fluid therapy and 19.5% received education on disease diagnosis and management. Conclusion Supportive management can be optimised, with a significant need to address patient education to minimise recurrence. Our data supports the use of targeted scoring systems in patients who are already critically ill. As the majority of cases were mild, we propose that the Modified Glasgow score is a useful aide but should not replace clinical judgment and careful monitoring of patients. Potential ambulatory pathways could be considered for mild acute pancreatitis.