Methodist Acute Pancreatitis Protocol

1.1. Background

Acute pancreatitis (AP) represents a significant burden for patients, their caregivers, and our healthcare delivery systems. The most common discharge gastrointestinal diagnosis is AP and more than two billion dollars is spent annually for management thereof . Costs are certainly even higher as the incidence of AP has increased. Admit frequency for AP doubled in 15 years before 2002 such that more than 200,000 admissions were attributed to AP, and the trend toward increased admissions for AP has continued. Overall, about 20% of AP cases are severe and the risk for fatality attributed to severe AP is significant (> 25%). Classification of AP severity is defined into three groups: mild, moderately severe, and severe. These categories have been validated in that standard clinical outcomes correlate well with the severity of AP.

There are several principle gaps in knowledge with respect to AP. First, it remains challenging to initially predict the ultimate severity of acute pancreatitis . Some patients presenting with what is thought to be a mild attack of AP ultimately progress to having more severe disease. This is of utmost importance because outcomes of AP seem to be clearly related to very early diagnosis and appropriate initial management. For example, both morbidity and mortality for AP are closely related to persistent organ failure, which in theory might be prevented with very early appropriate management. It is also not clear if the existing data regarding prognostic scoring systems were influenced by early interventions. Secondly, we lack confirmatory data that following recommended guidelines for management of AP in fact results in improved clinical outcomes. It has been suggested that the care of AP patients has changed considerably during the last decade. One might assume that this change was in response to following one or all of several different guidelines produced by international societies. However, there is a paucity of outcomes data, particularly related to patients that have been cared for according to the recommended guidelines, and further investigation is warranted. Lastly, many AP studies include patients who had onset of symptoms more than several days prior to admission or transfer to a tertiary center; careful study is warranted in AP patients who present within one to two days of symptom onset.

The evaluation and treatment of all patients with AP according to specific guidelines embodies the principles of patient-centeredness research and improved clinical outcomes may also translate into better quality of life. Patients who suffer from severe AP that is complicated by pancreatic necrosis continue to have poor physical components of quality of life. However, the burden for patients with AP extends beyond the obvious clinical outcomes. Even as symptom scales from quality of life instruments improve following recovery, mental component scores remain significantly impaired.

1.2. AIMS/OBJECTIVES