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Acute pancreatitis in childhood - a comparative international study and tale of two cities
Adeline Salim1, Ampaipan Boonthai2, Pornthep Tanpowpong3
1Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
Insights
Causes of acute pancreatitis in children differ between the UK and Thailand, with higher mortality in Thailand linked to chronic conditions. Early diagnosis and local factors influence outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Epidemiology
Background:
- Acute pancreatitis (AP) in children presents unique etiological and management challenges.
- Comparative studies are essential to understand geographical variations in pediatric AP.
Purpose of the Study:
- To compare factors contributing to the etiology, management, and clinical outcomes of pediatric acute pancreatitis.
- To identify differences in AP presentation and outcomes between major centers in the UK and Thailand.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) diagnosed with AP between 2006-2016.
- Data collection included etiological factors, diagnostic methods, disease severity, complications, and mortality.
- Statistical comparison between patients from Liverpool (UK) and Bangkok (Thailand).
Main Results:
- Etiology varied significantly: medications and choledochal cysts in Thailand vs. gallstone disease and medications in the UK (P<0.01).
- Ultrasonography use was higher in the UK (74.3% vs. 49.1%, P<0.01).
- While most cases were mild, mortality was significantly higher in Thailand (27.8% vs. 9.5%, P=0.02), linked to co-morbidities.
Conclusions:
- Pediatric acute pancreatitis etiology differs between the UK and Thailand.
- Local patient factors and healthcare pathways may influence diagnosis and management.
- Higher mortality in Thailand is associated with underlying chronic medical conditions in vulnerable pediatric populations.
Backgrounds:
To compare factor(s) contributing to aetiology, management and clinical outcome(s) of paediatric patients acquiring acute pancreatitis (AP) at two major university paediatric surgical centres in Liverpool and Bangkok.
Methods:
All patients (<18 years) with an index diagnosis of AP (ICD 10 coding) during 2006-2016 were studied.
Results:
121 patients included n = 79 (65.3%) in Thailand versus n = 42 (34.7%) in the UK centre with no difference(s) in age at diagnosis at 10.4 ± 4.5 and 11.7 ± 6 years. (P = 0.12). Major AP aetiology(s) in Thailand were medications (39.2%) and choledochal cysts (8.9%). In the UK-gallstone disease (21.4%), and medications (16.7%) were leading factors (P < 0.01). Ultrasonography was deployed more frequently in the UK versus Thai centre (74.3% vs. 49.1%; P < 0.01). Pancreatitis was confirmed by imaging in 67.9% (Thai) and 62.9% (UK) patients (P = 0.47). Most patients at both centres had a mild-grade pancreatitis illness (95% Thai vs. 90.5% UK; P = 0.28) while 12.7% of Thai and 19% of UK children developed pancreatitis-related complication (P = 0.37). Overall mortality rate (%) was significantly higher in the Thai versus UK centre (27.8% vs. 9.5%; P = 0.02).
Conclusions:
Aetiology of acute pancreatitis appears to vary between UK and Thailand children. Timely early diagnosis and healthcare pathways may be driven by local patient-related factor(s). The higher mortality (%) observed in Thailand versus UK in this comparative study was linked to underlying co-existent chronic medical condition(s) in vulnerable patient cohorts.
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