Acute Pancreatitis in the Emergency Department

Authors

Gregory J. Lopez, BS, Thomas Jefferson UniversityFollow
Matt Hall, MD, Beth Israel Deaconess Medical Center
Matthew Babineau, MD, Dartmouth-Hitchcock Medical Center
Darshan Kothari, MD, Beth Israel Deaconess Medical Center
Ryan C. Burke, PhD, MPH, Beth Israel Deaconess Medical Center
Richard E. Wolfe, MD, Beth Israel Deaconess Medical Center
Sunil G. Sheth, MD, Beth Israel Deaconess Medical Center
Stephen Freedman, MD, Beth Israel Deaconess Medical Center
Nathan I. Shapiro, MD, Beth Israel Deaconess Medical Center
Carrie Tibbles, MD, Beth Israel Deaconess Medical Center

Document Type

Abstract

Publication Date

2-2019

Academic Year

2018-2019

Comments

Poster attached as supplemental file below.

Abstract

Introduction: Acute pancreatitis (AP) is a common emergency department (ED) presentation with a variety of outcomes. Stratifying AP severity with scoring systems can allow physicians to effectively manage patient disposition.

Objective: To identify ED pancreatitis patients who will likely be admitted to the ICU or be discharged within 48 hours, and to validate existing pancreatitis severity scores.

Methods: Patients with a final ED diagnosis of AP and/or lipase ≥ 3 times the upper limit of normal were enrolled in a prospective, observational chart review study. Parametric and non-parametric descriptive statistics were used to describe the patient population. Area under receiver operating curve (AUC) was used to determine the predictive accuracy of existing pancreatitis scores.

Results: Ranson criteria, Glasgow-Imrie (GI) criteria, Bedside Index of Severity in Acute Pancreatitis (BISAP), and Harmless Acute Pancreatitis Score (HAPS) were assessed. GI criteria (AUC = 0.77) had the highest predictive accuracy for ICU admission, while Ranson criteria (AUC = 0.62) had the highest predictive accuracy for early discharge. Mean scores of ICU patients were significantly (p < 0.05) higher than those of non-ICU patients in all four scoring systems; however, mean scores in ICU patients failed to meet the severe case threshold for all four scoring systems.

Discussion: Existing pancreatitis scoring systems cannot consistently predict AP severity in ED patients. The small difference in mean ICU and non-ICU patient scores illustrates the difficulty of using scoring systems to stratify AP severity in the ED. Further efforts to develop an ED-specific scoring system could allow physicians to more efficiently admit patients.

Recommended Citation

Lopez, Gregory J.; Hall, Matt; Babineau, Matthew; Kothari, Darsh; Burke, Ryan; Wolfe, Richard E.; Sheth, Sunil G.; Freedman, Stephen; Shapiro, Nathan I.; and Tibbles, Carrie, "Acute Pancreatitis in the Emergency Department" (2019). SKMC JeffMD Scholarly Inquiry, Phase 1, Project 1.

Language

English