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

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., Banks, P. A., & 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