Early Cross-Sectional Imaging In Acute Pancreatitis Does Not Change Clinical Outcomes

INTRODUCTION: Acute pancreatitis (AP) accounts for $2.6 billion in costs annually. The American College of Gastroenterology recommends cross-sectional imaging should be reserved for patients in whom the diagnosis is unclear, who fail to clinically improve within 48-72 hours after admission, or to evaluate for complications. Studies have shown that the majority of patients with mild AP have normal CT scans and the imaging results do not change management. We aim to compare the outcomes of patients admitted with AP who had early cross-sectional imaging (within 72 hours of admission) versus those who did not. METHODS: This was a retrospective study of patients who presented to the emergency department of a tertiary care center with acute pancreatitis from January 1, 2009 to December 31, 2019. Patients were identified based on diagnosis code for acute pancreatitis and were included if they presented with abdominal pain and had a lipase level greater than three times the upper limit of normal. Patients were excluded if they were less than 18 years of age, pregnant, or had trauma as the reason for the abdominal pain. RESULTS: Over the 11-year study period, 993 patients presented with abdominal pain and elevated lipase, meeting criteria for acute pancreatitis. Approximately half of the patients were female (49.3%) and overall average age was 53.8 years (Table 1). The most common etiologies of AP were biliary followed by alcohol. Early cross-sectional imaging was utilized in 60.9% of patients. There were no differences in incidence of bacteremia, need for ICU care, mortality, or readmission rate in patients who received cross-sectional imaging compared to those who did not. (Table 2). These findings remain consistent among patients with higher BISAP scores. Longer length of stay was associated with those who had cross-sectional imaging (P < 0.01). CONCLUSION: Despite meeting diagnostic criteria for acute pancreatitis, 61% of our patients had early cross-sectional imaging. No difference in meaningful clinical outcomes were noted between the cohort that received early imaging versus no imaging, regardless of the severity of presentation. All stakeholders including gastroenterologists, emergency room physicians, and primary care teams should work in concert to generate institutional policies to eliminate the use of unnecessary imaging in AP, with hopes that future guidelines may reflect these findings and emphasize against the use of early cross-sectional imaging in the diagnosis of acute pancreatitis.Table 1.: Demographics and clinical characteristics of patients with acute pancreatitisTable 2.: Outcomes of patients undergoing early cross-sectional imaging versus those who did not