Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis

David X. Jin, Julia Y. McNabb-Baltar, Shadeah L. Suleiman, Bechien U. Wu, Ramin Khorasani, Thomas L. Bollen, Peter A. Banks, Vikesh Singh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalDigestive Diseases and Sciences
DOIs
StateAccepted/In press - Aug 24 2017

Fingerprint

Pancreatitis
Tomography
Magnetic Resonance Spectroscopy
Systemic Inflammatory Response Syndrome
Quality Improvement
Hospital Emergency Service
Comorbidity
Hospitalization
Logistic Models
Magnetic Resonance Imaging
Demography
Guidelines

Keywords

  • Computed tomography
  • CT
  • Magnetic resonance
  • MRI
  • Quality improvement

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Jin, D. X., McNabb-Baltar, J. Y., Suleiman, S. L., Wu, B. U., Khorasani, R., Bollen, T. L., ... Singh, V. (Accepted/In press). Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis. Digestive Diseases and Sciences, 1-6. https://doi.org/10.1007/s10620-017-4720-x

Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis. / Jin, David X.; McNabb-Baltar, Julia Y.; Suleiman, Shadeah L.; Wu, Bechien U.; Khorasani, Ramin; Bollen, Thomas L.; Banks, Peter A.; Singh, Vikesh.

In: Digestive Diseases and Sciences, 24.08.2017, p. 1-6.

Research output: Contribution to journalArticle

Jin, DX, McNabb-Baltar, JY, Suleiman, SL, Wu, BU, Khorasani, R, Bollen, TL, Banks, PA & Singh, V 2017, 'Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis', Digestive Diseases and Sciences, pp. 1-6. https://doi.org/10.1007/s10620-017-4720-x
Jin DX, McNabb-Baltar JY, Suleiman SL, Wu BU, Khorasani R, Bollen TL et al. Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis. Digestive Diseases and Sciences. 2017 Aug 24;1-6. https://doi.org/10.1007/s10620-017-4720-x
Jin, David X. ; McNabb-Baltar, Julia Y. ; Suleiman, Shadeah L. ; Wu, Bechien U. ; Khorasani, Ramin ; Bollen, Thomas L. ; Banks, Peter A. ; Singh, Vikesh. / Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis. In: Digestive Diseases and Sciences. 2017 ; pp. 1-6.
@article{e9b95313c718419eae7d1caf101b4162,
title = "Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis",
abstract = "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.",
keywords = "Computed tomography, CT, Magnetic resonance, MRI, Quality improvement",
author = "Jin, {David X.} and McNabb-Baltar, {Julia Y.} and Suleiman, {Shadeah L.} and Wu, {Bechien U.} and Ramin Khorasani and Bollen, {Thomas L.} and Banks, {Peter A.} and Vikesh Singh",
year = "2017",
month = "8",
day = "24",
doi = "10.1007/s10620-017-4720-x",
language = "English (US)",
pages = "1--6",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Plenum Publishers",

}

TY - JOUR

T1 - Early Abdominal Imaging Remains Over-Utilized in Acute Pancreatitis

AU - Jin, David X.

AU - McNabb-Baltar, Julia Y.

AU - Suleiman, Shadeah L.

AU - Wu, Bechien U.

AU - Khorasani, Ramin

AU - Bollen, Thomas L.

AU - Banks, Peter A.

AU - Singh, Vikesh

PY - 2017/8/24

Y1 - 2017/8/24

N2 - 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.

AB - 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.

KW - Computed tomography

KW - CT

KW - Magnetic resonance

KW - MRI

KW - Quality improvement

UR - http://www.scopus.com/inward/record.url?scp=85028353491&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028353491&partnerID=8YFLogxK

U2 - 10.1007/s10620-017-4720-x

DO - 10.1007/s10620-017-4720-x

M3 - Article

SP - 1

EP - 6

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

ER -