Highlights This study reviews the literature on suicide during outbreaks, including COVID-19. Nine studies were included in the qualitative synthesis. Deducing an association between outbreaks and suicide is poorly supported. High-quality research would allow for a better understanding of this interrelation.

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Background Serum lipase is a rapid and reliable laboratory test central to diagnosing acute pancreatitis (AP). Routine use in the emergency department (ED) setting for all cases of abdominal pain or as part of a standard laboratory biochemical profile may lead to unnecessary expenses. Aim To examine the utility of serum lipase determination at a tertiary care centre ED. Methods Retrospective cross‐sectional study of ED patients having serum lipase determination over a 12‐month period. Electronic medical records were reviewed for indication and interpretation leading to additional diagnostic imaging, specialist consultation, interventions or hospital admission. Results A total of 24 133 adult patients visited the ED during the study period: 4976 (20.6%) had serum lipase determination, 614 (12.4%) had abnormal lipase, 130 of which (21.1%) were above the diagnostic threshold for acutre pancreatitis (AP) (>3× ULN). A total of 75 patients had confirmed AP (0.3% of all adult ED visits). The positive and negative predictive values of serum lipase (>3× ULN) for AP were 43.6% and 99.6%, respectively. One thousand eight hundred and ninety patients (38.0%) had no abdominal pain on history or physical examination. In this group, the total charge associated with lipase determination was $51 030 with 251 (13.3%) elevated lipase values triggering cross‐sectional abdominal imaging in 61 (24.3%) patients and unwarranted gastroenterology consultation in three (1.2%) for an additional charge of $28 975. Conclusions Serum lipase is widely overutilised in the emergency setting resulting in unnecessary expenses and investigations. Evidence‐based review of clinical guidelines and more restrictive testing can result in substantial cost savings and improved patient care.