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• W2912736092 abstract "Introduction: Guidelines for management of acute pancreatitis (AP), including appropriate imaging, were published (2013). The AP published guidelines (APPG) recommend chest x-ray (CXR) and abdominal ultrasound (US) for initial imaging. Emergency room (ER) CT scans are discouraged unless the diagnosis is unclear. The aims of this study were to report the effects of a quality initiative evaluating adherence to imaging recommendations and to determine outcomes in patients managed per APPG. Methods: The Dallas Acute Pancreatitis Protocol (DAPP) entails computer physician orders (e.g. fluid resuscitation, enteral feeding), physician and nursing education, and patient navigator to optimize adherence to APPG. Retrospective data from 8/2011-12/2014 and prospective data from 1/2015-12/2016 were analyzed. Patients were included if admitted for AP and at least 2 of 3 following criteria were met: (i) pain consistent with AP, (ii) serum amylase and/or lipase >3X ULN, and (iii) characteristic imaging finding. Exclusion criteria included: age < 18 years, transfers, post-ERCP AP, and trauma. Measured outcomes included initial diagnostic imaging, adherence to the APPG, and clinical outcomes (local and systemic complications). Final outcomes were defined as mild, moderately severe and severe as defined by the APPG. Results: Retrospective data of 220 patients and prospective data from 228 patients were evaluated. The most commonly identified etiologies (Table 1) in both cohorts were biliary and alcohol. Initiation of DAPP resulted in an increase in the utilization of abdominal US (58.3% v 83%, p < 0.001) and CXR (35.5% v 72.4%, p < 0.001). There was a 50.4% (24.6% v 51.8%, p < 0.01) reduction in the number of CT scans in the ER. Subgroup analysis of the prospective arm showed no difference in AP severity regardless of whether a CT scan was performed in the ER (P=0.079). Final severity of AP was improved after initiation of DAPP (Table 1). There were no deaths in the prospective group compared to 12 (5.5%) in the retrospective group. Compared to the prospective group, the retrospective cohort was more likely to have severe AP compared to mild AP (OR = 6.91; 95% CI 1.49-64.11) or moderately severe AP (OR = 4.67; 95% CI 0.90-45.54).Table: Table. Etiology, Imaging, and Outcomes in Acute PancreatitisConclusion: Data from AP patients managed prior to published guidelines suggested a need to improve initial imaging utilization. Implementation of our programmatic quality initiative with DAPP reduced the use of CT scans by 50.4% overall without an increase in severity outcomes." @default.
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• W2912736092 date "2017-10-01" @default.
• W2912736092 modified "2023-09-27" @default.
• W2912736092 title "Initial Imaging in Patients With Acute Pancreatitis: Impact of Quality Improvement" @default.
• W2912736092 doi "https://doi.org/10.14309/00000434-201710001-00004" @default.
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