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Changing referral trends of acute pancreatitis in children: A 12-year single-center analysis
Alexander Park1, Sahibzada Usman Latif, Ahsan U Shah
1Department of Pediatrics, Yale University, New Haven, CT, USA.
Insights
Pediatric acute pancreatitis incidence may be rising due to increased referrals to tertiary care centers, not necessarily a true increase in cases. Etiology data can aid in managing children with this painful inflammatory disorder.
Area of Science:
- Pediatric Gastroenterology
- Clinical Epidemiology
Background:
- Acute pancreatitis is a painful inflammatory condition in children.
- Recent adult data suggest increasing incidence, but pediatric evidence is limited.
Purpose of the Study:
- To investigate the frequency of pediatric acute pancreatitis from 1994 to 2007.
- To characterize the causes of acute pancreatitis across different age groups in children.
Main Methods:
- Retrospective analysis of pediatric pancreatitis cases identified via ICD-9 codes.
- Inclusion criteria applied to confirm pancreatitis diagnosis.
Main Results:
- 271 pediatric pancreatitis cases were identified; mean age was 13.1 years.
- Biliary disease was the most common cause (32.6%); recurrence rate was 15.3%.
- A 53% increase in pancreatitis cases at a tertiary center was observed, but normalized for emergency visits, the rise was 22% and not statistically significant.
Conclusions:
- Increased referrals to tertiary care centers may contribute to the apparent rise in pediatric pancreatitis.
- Understanding etiologies by age is crucial for effective management of pediatric acute pancreatitis.
Background:
Acute pancreatitis is a painful inflammatory disorder known to occur in children. Recent reports, primarily on the basis of adult data, have suggested an increasing incidence. However, pediatric studies are limited.
Objective:
The study was performed to examine the frequency of acute pancreatitis in a pediatric population from 1994 to 2007 and to characterize etiologies by age subsets.
Patients And Methods:
In this retrospective study, cases of pancreatitis were identified by ICD-9 codes and subjected to inclusion criteria.
Results:
Two hundred and seventy-one cases of pancreatitis met inclusion criteria. Mean age of the subjects was 13.1 +/- 5.6 years. The recurrence rate was 15.3%. Biliary disease was the most common etiology (32.6%). Acute pancreatitis cases evaluated at a single tertiary care center increased 53% between 1995 to 2000 and 2001 to 2006 (P < 0.02). However, when cases were normalized by all annual pediatric emergency department visits for all medical reasons, the increase was reduced to 22% and lost statistical significance (P = 0.16). The rise was not associated with a change in etiologies or body mass index (BMI).
Conclusions:
This is the first report demonstrating that an increase in pediatric pancreatitis may in part be due to growing referrals to tertiary care centers. The data on etiologies, particularly with regard to differing ages, may be helpful in managing children who present with acute pancreatitis.
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