Reynolds Paul T, Brady Evan K, Chawla Saurabh
Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA.
Grady Memorial Hospital (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA.
Ann Gastroenterol. 2018 Sep-Oct;31(5):628-632. doi: 10.20524/aog.2018.0291. Epub 2018 Jul 13.
There are roughly 300,000 hospitalizations for acute pancreatitis annually in the United States. Many of the affected patients at our institution undergo computed tomography (CT) or magnetic resonance imaging (MRI) unnecessarily early during their admissions. We hypothesize that cross-sectional imaging within 48 h of admission in patients meeting the criteria for acute, mild pancreatitis is over-utilized and does not change management.
We performed a retrospective analysis of patients with a discharge diagnosis of acute pancreatitis from our tertiary care institution from January 1, 2010 to December 31, 2015. Inclusion criteria were a lipase more than three times the upper limit of normal and clinical suspicion of pancreatitis. Exclusion criteria were an etiology of pancreatitis following endoscopic retrograde cholangiopancreatography, recurrent or chronic pancreatitis, severe pancreatitis, and ultrasound findings being the reason for imaging.
Of the 166 patients who met the criteria for analysis, 105 (63.3%) underwent cross-sectional imaging within 48 h of presentation (CT: 104, MRI: 1). Of the examined CTs, 27 (26.0%) showed no abnormality and 55 (52.9%) revealed uncomplicated pancreatitis. The remaining 22 (21.2%) demonstrated at least one of the following: local complications, biliary ductal dilatation or other findings. On thorough chart review, only two patients received a beneficial change in management as a result of the early imaging.
This analysis supports current guidelines that early cross-sectional abdominal imaging (CT or MRI) in patients with suspected acute mild pancreatitis does not alter medical management. Early imaging may lead to unnecessary resource use and patient irradiation.
在美国，每年约有30万例急性胰腺炎住院病例。我们机构的许多受影响患者在入院期间过早地接受了计算机断层扫描（CT）或磁共振成像（MRI）检查。我们假设，符合急性轻症胰腺炎标准的患者在入院48小时内进行的横断面成像检查存在过度使用的情况，且并未改变治疗方案。
我们对2010年1月1日至2015年12月31日期间在我们三级医疗机构出院诊断为急性胰腺炎的患者进行了回顾性分析。纳入标准为脂肪酶高于正常上限的三倍且临床上怀疑患有胰腺炎。排除标准为内镜逆行胰胆管造影术后胰腺炎病因、复发性或慢性胰腺炎、重症胰腺炎以及超声检查结果作为成像的原因。
在166例符合分析标准的患者中，105例（63.3%）在就诊后48小时内接受了横断面成像检查（CT：104例，MRI：1例）。在检查的CT中，27例（26.0%）未显示异常，55例（52.9%）显示为非复杂性胰腺炎。其余22例（21.2%）至少表现出以下情况之一：局部并发症、胆管扩张或其他发现。通过全面查阅病历，仅有两名患者因早期成像检查而使治疗方案得到了有益的改变。
该分析支持当前指南，即疑似急性轻症胰腺炎患者早期进行腹部横断面成像检查（CT或MRI）不会改变医疗管理。早期成像检查可能导致不必要的资源使用和患者辐射。
