Prospective evaluation of an emergency department protocol to prevent hospitalization in mild acute pancreatitis: Outcomes and predictors of discharge

Anderson, Kelsey; Shah, Ishani; Yakah, William; Cartelle, Anabel Liyen; Zuberi, Shaharyar; McHenry, Nicole; Horton, Laura; Ahmed, Awais; Freedman, Steven D.; Kothari, Darshan; Sheth, Sunil G.

doi:10.1016/j.pan.2023.02.006

Cited by 5 publications

(8 citation statements)

References 16 publications

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“…Only two studies with a similar objective have ever been reported,10 11 and a treatment failure rate of 4%–12% was observed in the home monitoring (outpatient/home care) group. Using calculations for a non-inferiority study with an estimated 95% success rate, 80% power, 5% significance level and 10% inferiority limit, a sample size of 75 patients per study group was calculated (total=225 patients).…”

Section: Methodsmentioning

confidence: 93%

“…This proposed study seeks to prospectively evaluate a new scope in the care of patients with MAP and is justified based on these three points: (1) patients with MAP usually achieve a complete recovery of their symptoms in less than a week with conservative management (intravenous hydration, analgesia and early diet); (2) clinical prognostic scoring systems, although criticised for their poor positive predictive value for severe AP, have an excellent negative predictive value to determine which patients will have MAP early in their hospitalisation; and (3) factors that predict hospital readmission within 30 days in AP have been studied and can be applied 8–15…”

Section: Introductionmentioning

confidence: 99%

“…Ince et al 10 showed that MAP can be safely treated at home with regular visits by a nurse under the supervision of a physician with large cost-savings. A recent cohort study, which included 419 patients, showed that after appropriate triage, patients with MAP can be safely discharged from the emergency room (ER) after a mean of 12 hours with improved outcomes and cost-savings 11…”

Section: Introductionmentioning

confidence: 99%

“…A recent cohort study, which included 419 patients, showed that after appropriate triage, patients with MAP can be safely discharged from the emergency room (ER) after a mean of 12 hours with improved outcomes and cost-savings. 11 …”

Section: Introductionmentioning

confidence: 99%

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Home care/outpatient versus hospital admission in mild acute pancreatitis: protocol of a multicentre, randomised controlled trial (PADI_2 trial)

Ramírez-Maldonado,

Rodrigo-Rodrigo,

Lopez Gordo

et al. 2023

BMJ Open

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IntroductionAcute pancreatitis (AP) is the third most common gastrointestinal disease resulting in hospital admission, with over 70% of AP admissions being mild cases. In the USA, it costs 2.5 billion dollars annually. The most common standard management of mild AP (MAP) still is hospital admission. Patients with MAP usually achieve complete recovery in less than a week and the severity predictor scales are reliable. The aim of this study will be to compare three different strategies for the management of MAP.Methods/designThis is a randomised, controlled, three-arm multicentre trial. Patients with MAP will be randomly assigned to group A (outpatient), B (home care) or C (hospital admission). The primary endpoint of the trial will be the treatment failure rate of the outpatient/home care management for patients with MAP compared with that of hospitalised patients. The secondary endpoints will be pain relapse, diet intolerance, hospital readmission, hospital length of stay, need for intensive care unit admission, organ failure, complications, costs and patient satisfaction. The general feasibility, safety and quality checks required for high-quality evidence will be adhered to.Ethics and disseminationThe study (version 3.0, 10/2022) has been approved by the Scientific and Research Ethics Committee of the ‘Institut d’Investigació Sanitaria Pere Virgili-IISPV’ (093/2022). This study will provide evidence as to whether outpatient/home care is similar to usual management of AP. The conclusions of this study will be published in an open-access journal.Trial registration numberClinicalTrials.gov Registry (NCT05360797).

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Section: Methodsmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Home care/outpatient versus hospital admission in mild acute pancreatitis: protocol of a multicentre, randomised controlled trial (PADI_2 trial)

Ramírez-Maldonado,

Rodrigo-Rodrigo,

Lopez Gordo

et al. 2023

BMJ Open

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“…Compared to the initial study that had direct oversight by the GI team, the follow up study demonstrated that the ED providers could use the clinical pathway autonomously suggesting the ease of implementation and generalizability to institutions without GI providers. Using the availability data, we found that older age, greater medical comorbidity, and biliary pancreatitis were predictors for admission rather than observation whereas patients with idiopathic pancreatitis were nearly eight times more likely to be observed[ 30 ].…”

Section: Main Textmentioning

confidence: 99%

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

Kothari,

Sheth

2024

World J Gastroenterol

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Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, resulting in 300000 admissions per year with an estimated cost of over $2.6 billion annually. The severity of AP is determined by the presence of pancreatic complications and end-organ damage. While moderate/severe pancreatitis can be associated with significant morbidity and mortality, the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%. Despite favorable outcomes, the majority of mild AP patients are admitted, contributing to healthcare cost and burden. In this Editorial we review the performance of an emergency department (ED) pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations, resource utilization, and costs after several years of implementation of the pathway. We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital, and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway. We conclude that by implementing innovative clinical pathways which are established and reproducible, selected AP patients can be safely discharged from the ED, reducing hospitalizations and healthcare costs, without compromising clinical outcomes. We also identify a subset of patients most likely to succeed in this pathway.

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Serum Lactate Is an Indicator for Short-Term and Long-Term Mortality in Patients with Acute Pancreatitis

Zeng,

Huang,

Lin

et al. 2024

Dig Dis Sci

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Prospective evaluation of an emergency department protocol to prevent hospitalization in mild acute pancreatitis: Outcomes and predictors of discharge

Cited by 5 publications

References 16 publications

Home care/outpatient versus hospital admission in mild acute pancreatitis: protocol of a multicentre, randomised controlled trial (PADI_2 trial)

Home care/outpatient versus hospital admission in mild acute pancreatitis: protocol of a multicentre, randomised controlled trial (PADI_2 trial)

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

Serum Lactate Is an Indicator for Short-Term and Long-Term Mortality in Patients with Acute Pancreatitis

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