Optimizing Imaging Adherence in Acute Pancreatitis: A Clinical Audit at a District General Hospital

In patients presenting with symptoms suggestive of acute pancreatitis, routine imaging is not necessary when abdominal pain and elevated serum amylase or lipase are present without signs of severe disease. Early CT scans may not accurately reflect disease severity and provide limited diagnostic benefit.

A retrospective clinical audit was conducted at a district general hospital in the United Kingdom to evaluate current imaging practices in acute pancreatitis. Adult patients presenting to the accident and emergency (A&E) department with symptoms of acute pancreatitis were included. Two audit cycles were performed: January-March 2023 (Cycle 1) and April-May 2024 (Cycle 2). Imaging timing, modality, and adherence to standards recommended by the Royal College of Radiologists were assessed. Interventions to improve guideline compliance were implemented between cycles.

In Cycle 1, 44 patients presented with acute pancreatitis symptoms; 24 (54%) underwent CT scans, of which 15 were performed within 72 hours. Serum amylase was checked in all patients. Imaging findings consistent with pancreatitis were observed in 80% of cases, including one case of pancreatic necrosis, seven cases of intraperitoneal fluid, and five cases of peripancreatic fat stranding. Ultrasound within 24 hours was infrequently performed. Post-intervention (Cycle 2), 32 patients were assessed, with 15 (46.8%) undergoing CT scans, of which three were performed within 72 hours. Serum amylase was checked in all patients. Awareness efforts, including departmental presentations and posters, contributed to improved compliance.

This closed-loop clinical audit demonstrates that targeted interventions and increased awareness of imaging guidelines can improve adherence among clinicians, reducing unnecessary radiation exposure and optimizing CT scan utilization in acute pancreatitis.