McNabb-Baltar Julia, Ravi Praful, Isabwe Ghislaine Annie, Suleiman Shadeah Laila, Yaghoobi Mohammad, Trinh Quoc-Dien, Banks Peter A
From the *Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; †Division of Gastroenterology, McGill University, Montreal, Canada; ‡Center for Outcomes Research and Analytics, Henry Ford Health System, Detroit, MI; §Division of Gastroenterology, University of South Carolina, Charleston, SC; ∥Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; and ¶Harvard School of Public Health, Boston, MA.
Pancreas. 2014 Jul;43(5):687-91. doi: 10.1097/MPA.0000000000000123.
The aim of this study is to investigate the incidence and mortality of emergency department (ED) visits in the United States attributed to acute pancreatitis (AP) and quantify predictors of admission and mortality.
Using the nationwide ED sample, all ED visits between 2006 and 2009 for AP were extracted. Multivariable analyses were fitted for prediction of admission and mortality.
A weighted sample of 1,224,121 patient visits with AP was captured. Of those, 75.4% resulted in admission and 0.7% died. Between 2006 and 2009, the incidence of AP ED visits increased from 9.9 to 10.6 per 10,000 person-years. Patients were more likely to be admitted if sicker (Charlson Comorbidity Index score ≥ 3; OR, 6.48; P < 0.001) and if the etiology of pancreatitis was alcoholic versus biliary (OR, 2.20; P < 0.001). They were more likely to die if sicker (Charlson Comorbidity Index score ≥ 3; OR, 1.51; P < 0.001) and covered with Medicare or Medicaid versus private insurance (OR, 1.40; P < 0.001 and OR, 1.45; P < 0.001, respectively).
Emergency department visits for AP represent a significant burden on US health care. Although mortality is lower than previously reported, significant disparities exist in patients presenting with AP with regard to admission and mortality rates. Further investigations are needed to assess these disparities.
本研究旨在调查美国急诊科因急性胰腺炎（AP）就诊的发病率和死亡率，并量化入院和死亡的预测因素。
使用全国急诊科样本，提取2006年至2009年间所有因AP的急诊科就诊病例。采用多变量分析来预测入院和死亡情况。
共获取了1224121例AP患者就诊的加权样本。其中，75.4%的患者入院，0.7%的患者死亡。2006年至2009年间，AP急诊科就诊的发病率从每10000人年9.9例增至10.6例。病情较重的患者（Charlson合并症指数评分≥3；比值比[OR]为6.48；P<0.001）以及胰腺炎病因是酒精性而非胆源性的患者（OR为2.20；P<0.001）更有可能入院。病情较重的患者（Charlson合并症指数评分≥3；OR为1.51；P<0.001）以及参保医疗保险或医疗补助而非私人保险的患者（分别为OR为1.40；P<0.001和OR为1.45；P<0.001）更有可能死亡。
AP的急诊科就诊给美国医疗保健带来了重大负担。尽管死亡率低于先前报道，但AP患者在入院率和死亡率方面存在显著差异。需要进一步调查以评估这些差异。
