Does early ED CT scanning of afebrile patients with first episodes of acute pancreatitis ever change management?

Abstract

Rising utilization of computed tomography (CT) imaging early in the course of acute pancreatitis (AP) has been recently reported. However, radiographic demonstration of the degree of necrosis or the presence of complications is not fully apparent within the first days of an acute attack. The objective of this study was to examine if CT scanning early in the course of disease (<48 h of symptoms) in afebrile patients with an emergency department (ED) diagnosis of first episode of AP revealed any unanticipated pathology that altered clinical management. A retrospective chart review of all adult patients with a first episode of AP without fever admitted to the medical ward through the ED of our community hospital from January 1, 2011 to May 31, 2012 was performed. In cases in which CT scans were performed, the record was reviewed to determine if any unexpected findings were uncovered or if patient care was altered by the CT report. Two hundred forty-eight patients were admitted with an ED diagnosis of AP; 26.2 % (n = 65) met inclusion criteria; 70.8 % (n = 46) received a CT scan within 48 h of symptom onset. No patient that underwent CT scanning had an unexpected finding (95 % CI, 0.923–1.0). Our results demonstrate that afebrile patients with first episodes of AP do not benefit from early abdominal CT imaging. These results support the ACR Appropriateness Criteria recommendation that CT is not indicated in the first 48 h after symptom onset in unequivocal cases of AP.