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Variability in Pancreatitis Care in Pediatrics: A Single Institution's Survey Report
Maisam Abu-El-Haija1, Joseph J Palermo, Lin Fei
1From the *Division of Pediatric Gastroenterology, Hepatology and Nutrition and †Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Pediatric acute pancreatitis (AP) management lacks consensus among specialists. Developing evidence-based guidelines is crucial for consistent treatment of childhood AP.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Patterns
- Acute Pancreatitis Management
Background:
- Childhood acute pancreatitis (AP) incidence has risen.
- Current AP management in children largely relies on adult studies.
- Lack of pediatric-specific treatment consensus exists.
Purpose of the Study:
- To assess treatment consensus for acute pancreatitis (AP) among pediatric subspecialists.
- To identify variations in managing uncomplicated AP in children.
Main Methods:
- Survey of pediatric subspecialists managing AP admissions.
- Analysis of practice patterns for diagnostic evaluation, fluid resuscitation, pain management, and nutrition.
- Data collected from November 2009 to August 2013.
Main Results:
- Significant variability in AP management practices was observed.
- Practices differed between and within subspecialty groups.
- Gastroenterology and hospitalist services admitted most AP patients.
Conclusions:
- A consensus on managing acute uncomplicated pancreatitis in children is lacking.
- Development of evidence-based pediatric guidelines is recommended.
- Standardized guidelines can improve consistency in pediatric AP care.
Objective:
The incidence of acute pancreatitis (AP) in childhood has increased in the last 2 decades, yet management has been largely extrapolated from adult studies. We sought to determine whether there is a consensus for treatment of AP among different pediatric subspecialists.
Methods:
Providers from subspecialties seeing most patients admitted for AP were surveyed on their practice patterns in managing a first attack of uncomplicated AP.
Results:
From November 2009 to August 2013, there were 284 admissions for patients with AP to our center. Patients were primarily admitted to the gastroenterology or hospitalist service (39% and 26%, respectively). Survey results found practice patterns for diagnostic evaluation, fluid resuscitation, pain management, and introduction of nutrition were variable between practitioners belonging to different subspecialties as well as within the same subspecialty group.
Conclusions:
There is a lack of consensus on management of acute uncomplicated pancreatitis among pediatric providers, which may be improved through development of evidence-based pediatric guidelines.
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