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Observational Study
. 2019 Sep;101(7):487-494.
doi: 10.1308/rcsann.2019.0055. Epub 2019 Jul 30.

Population-based observational study of acute pancreatitis in southern England

PanWessex Study Group  1 ; Wessex Surgical Trainee Research Collaborative  1 ; Alex Mirnezami, Ben Knight, Brendan Moran, Fergus Noble, Graham Branagan, John Primrose, Katherine Pearson, Malcolm West, Nathan Curtis, Phil Pucher, Ramsey Cuttress, Sian Pugh, Tim Underwood
Affiliations
Observational Study

Population-based observational study of acute pancreatitis in southern England

PanWessex Study Group et al. Ann R Coll Surg Engl. 2019 Sep.

Abstract

Introduction: Acute pancreatitis is a common surgical emergency. Identifying variations in presentation, incidence and management may assist standardisation and optimisation of care. The objective of the study was to document the current incidence management and outcomes of acute pancreatitis against international guidelines, and to assess temporal trends over the past 20 years.

Methods: A prospective four-month audit of patients with acute pancreatitis was performed across the Wessex region. The Atlanta 2012 classifications were used to define cases, severity and complications. Outcomes were recorded using validated systems and correlated against guideline standards. Case ascertainment was validated with clinical coding and hospital episode statistics data.

Results: A total of 283 patient admissions with acute pancreatitis were identified. Aetiology included 153 gallstones (54%), 65 idiopathic (23%), 29 alcohol (10%), 9 endoscopic retrograde cholangiopancreatography (3%), 6 drug related (2%), 5 tumour (2%) and 16 other (6%). Compliance with guidelines had improved compared with our previous regional audit. Results were 6.5% mortality, 74% severity stratification, 23% idiopathic cases, 65% definitive treatment of gallstones within 2 weeks, 39% computed tomography within 6-10 days of severe pancreatitis presentation and 82% severe pancreatitis critical care admission. The Atlanta 2012 severity criteria significantly correlated with critical care stay, length of stay, development of complications and mortality (2% vs 6% vs 36%, P < 0.0001).

Conclusions: The incidence of acute pancreatitis in southern England has risen substantially. The Atlanta 2012 classification identifies patients with severe pancreatitis who have a high risk of fatal outcome. Acute pancreatitis management is seen to have evolved in keeping with new evidence and updated clinical guidelines.

Keywords: Acute pancreatitis; Audit; Epidemiology; Management.

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Figures

Figure 1
Figure 1
Audit design and participant flow chart.
Figure 2
Figure 2
Time from onset of abdominal pain to hospital attendance.
See this image and copyright information in PMC

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