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Erschienen in:
24.08.2017 | Original Article
Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis
Erschienen in: Digestive Diseases and Sciences | Ausgabe 10/2017
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Background
Early abdominal computed tomography (CT) or magnetic resonance (MR) imaging is common in acute pancreatitis (AP). Guidelines (2007–2013) indicate routine use is unwarranted.
Aims
To compare the frequency and evaluate the predictors of early CT/MR utilization for AP between September 2006–2007 (period A) and September 2014–2015 (period B).
Methods
AP patients presenting directly to a large academic emergency department were prospectively enrolled during each period. Cases requiring imaging to fulfill diagnostic criteria were excluded. Early CT/MR (within 24 h of presentation) utilization rates were compared using Fisher’s exact test. Predictors of early imaging usage were assessed with multivariate logistic regression.
Results
The cohort included 96 AP cases in period A and 97 in period B. There were no significant differences in patient demographics, comorbidity scores, or AP severity. Period B cases manifested decreased rates of the systemic inflammatory response syndrome (SIRS) during the first 24 h of hospitalization (67% period A vs. 43% period B, p = 0.001). Independent predictors of early imaging included age >60 and SIRS or organ failure on day 1. No significant decrease in early CT/MR usage was observed from period A to B on both univariate (49% period A vs. 40% period B, p = 0.25) and multivariate (OR 1.0 for period B vs. A, 95% CI 0.5–1.9) analysis.
Conclusions
In a comparison of imaging practices for AP, there was no significant decrease in early abdominal CT/MR utilization from 2007 to 2015. Quality improvement initiatives specifically targeting early imaging overuse are needed.