Changing Referral Trends of Acute Pancreatitis in Children: A 12‐year Single‐center Analysis

Abstract

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.

Acute pancreatitis in children: a tertiary hospital report

“…The current incidence seems to be around 3.6-13.2 cases per 100,000 individuals per year, according to some studies from Australia and United States [1,2,[7][8][9]. The reasons for this increase are not entirely clear and could represent more a geographic than a worldwide phenomenon.…”

“…The reasons for this increase are not entirely clear and could represent more a geographic than a worldwide phenomenon. However, it could result from greater physician awareness or changing trends in pancreatitis etiologies [7][8][9][10][11].…”

Incidence and Clinical Associations of Childhood Acute Pancreatitis

“…The proportion of gallstone cases in our study (13%) was comparable to recent studies from France (13%), 23 and America (12%), 24 and higher than in Italy (6%), 25 but less than the 26% reported in another large American study. 4 We found trauma and mumps, previously the most commonly reported associations in the UK, One explanation might be that children these days are overly protected by their parents, less active, and spend more time sitting watching TV or playing electronic games than being outdoors. In addition, the younger age of our cohort may also be pertinent, as trauma is more common in older teenagers.…”

“…AP has been associated with systemic diseases in 2-53% cases in paediatric series. 2,[4][5][6]21,23,24,26,29 This variation may be partly due to differences in the definition of AP and age of patients and to the variations in classification and assigning the associated agents. The changing incidence in Australia was attributed in part to an increase in cases associated with systemic illnesses.…”

“…1 AP is uncommon in children, but leads to significant morbidity in the short, medium and long-term. Recently, an increase in the number of paediatric AP cases in single institutions has been reported by centres in the USA, [2][3][4][5] Australia, 6 and Mexico. 7 However, these studies are retrospective reviews and the incidence of AP is usually reported as an absolute number of cases per centre per year at individual referral institutions.…”