Assessing the CT findings and clinical course of ED patients with first-time versus recurrent acute pancreatitis.

STUDY OBJECTIVES: The primary objective of this study was to compare Emergency Department patients with first-time versus recurrent acute pancreatitis. METHODS: This study was a retrospective chart review of patients with a diagnosis of acute pancreatitis who presented to a single academic urban emergency department from 2012 to 2016. Criteria for inclusion were clinical symptoms of pancreatitis, age greater than or equal to 18 years, ED diagnosis of acute pancreatitis, and an abdominal CT scan within 24 h of triage. Exclusion criteria were traumatic mechanism and pregnancy. Charts were reviewed by a minimum of two trained abstractors using structured data collection sheets and discrepancies were resolved by a third abstractor. Patients with first time acute pancreatitis versus recurrent acute pancreatitis were compared to determine differences in characteristics, management and disposition. RESULTS: 250 patients were included in the study. Of these, 165 patients had first-time acute pancreatitis and 85 patients had recurrent acute pancreatitis. Demographics, vital signs and initial lab values were the same in both groups. Patients with recurrent acute pancreatitis were more likely to have significant findings on CT (Modified CT Severity Index, 2.09 versus 1.43, p < 0.05), more likely to require IV opiates (96% versus 75%, p < 0.001) and less likely to need ICU admission (8% versus 19%, p = 0.03). CONCLUSION: ED patients with recurrent acute pancreatitis demonstrated more significant findings on CT compared to patients with first-time acute pancreatitis but were less likely to require ICU admission.

Exploring the attitudes & practices of shared decision-making for CT scan use in emergency department patients with abdominal pain.

BACKGROUND: Shared decision-making (SDM) has been studied in the emergency department (ED) in relation to hospital admissions but not for CT scan utilization. CT scans are a common imaging modality with high accuracy that emit considerable ionizing radiation. This study has three aims: to measure provider and patient preference for SDM; to evaluate patient involvement in the decision to order a CT scan; and to determine the association between patient involvement and CT utilization. METHODS: In this prospective study, stable ED patients with abdominal pain with CT imaging as a likely diagnostic tool, were screened and consented. The Control Preferences Scale assessed patient and provider baseline decision-making preference. Using the OPTION-5 tool, providers were assessed in each encounter for the extent to which they engaged patients in discussions. The association between the Control Preferences Scale, the OPTION-5 score and ultimate CT utilization was evaluated. RESULTS: Twenty-nine encounters were observed. CT was considered in 70% (n = 20) of encounters and ordered in 55% (n = 16). 62% of patients and 59% of providers reported that they prefer "shared responsibility" when making treatment decisions. In >80% of encounters, provider's showed no or minimal effort when discussing whether to perform a CT scan. Provider or patient preference was not associated with patient involvement. Patient involvement was not associated with CT utilization. CONCLUSIONS: High rates of provider and patient preference to use SDM for treatment plans were reported but providers were rarely observed engaging patients with abdominal pain in the decision to order a CT scan.