Jin David X, McNabb-Baltar Julia Y, Suleiman Shadeah L, Wu Bechien U, Khorasani Ramin, Bollen Thomas L, Banks Peter A, Singh Vikesh K
Division of Gastroenterology, Hepatology and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Division of Gastroenterology, Pancreatic Disease Center, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Dig Dis Sci. 2017 Oct;62(10):2894-2899. doi: 10.1007/s10620-017-4720-x. Epub 2017 Aug 24.
Early abdominal computed tomography (CT) or magnetic resonance (MR) imaging is common in acute pancreatitis (AP). Guidelines (2007-2013) indicate routine use is unwarranted.
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).
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.
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.
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.
早期腹部计算机断层扫描（CT）或磁共振成像（MR）在急性胰腺炎（AP）中很常见。指南（2007 - 2013年）表明常规使用并无必要。
比较2006年9月至2007年（A期）和2014年9月至2015年（B期）期间AP患者早期CT/MR检查的使用频率，并评估其预测因素。
在每个时间段前瞻性纳入直接就诊于大型学术急诊科的AP患者。排除需要影像学检查以满足诊断标准的病例。使用Fisher精确检验比较早期CT/MR（就诊后24小时内）的使用率。通过多因素逻辑回归评估早期影像学检查使用的预测因素。
该队列在A期包括96例AP病例，B期包括97例。患者人口统计学、合并症评分或AP严重程度方面无显著差异。B期病例在住院的前24小时内全身炎症反应综合征（SIRS）的发生率降低（A期为67% vs. B期为43%，p = 0.001）。早期影像学检查的独立预测因素包括年龄>60岁以及第1天出现SIRS或器官功能衰竭。在单因素分析（A期为49% vs. B期为40%，p = 0.25）和多因素分析（B期与A期相比的OR为1.0，95%CI为0.5 - 1.9）中，均未观察到从A期到B期早期CT/MR使用有显著下降。
在对AP影像学检查实践的比较中，2007年至2015年早期腹部CT/MR的使用率没有显著下降。需要针对早期影像学检查过度使用的质量改进措施。
