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Clinicians frequently noncompliant with ACG guidelines when diagnosing acute pancreatitis
LAS VEGAS — Clinicians ordered imaging tests that were considered unnecessary according to American College of Gastroenterology guidelines in more than 50% of evaluated cases in a study presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.
In a retrospective cohort study, researchers evaluated 50 randomly selected patients from a group of 409 with acute pancreatitis treated between January 2010 and January 2011 at Hackensack University Medical Center. Procedures performed on evaluated patients were assessed according to compliance with American College of Gastroenterology (ACG) and American College of Radiology (ACR) guidelines.
“Clinical symptoms, elevation of pancreatic enzymes and imaging of the pancreas are major evidence to diagnose pancreatitis,” the researchers wrote. “However, imaging is not always required to make the diagnosis of acute pancreatitis.”
Noncompliance with ACG guidelines was observed in 58% of evaluated cases, with 57% of those patients undergoing CT scans or abdominal ultrasounds, considered unnecessary in the absence of elevated lipase levels. By comparison, 10% of cases did not comply with ACR guidelines.
Researchers noted that ACG guidelines are stricter than ACR regarding the point at which imaging tests should be ordered and may explain differences in compliance. ACG indicates that imaging is not necessary to diagnose acute pancreatitis in the presence of abdominal pain consistent with the condition and lipase or amylase levels more than three times greater than normal. ACR guidelines include CT imaging results as one of three factors — along with abdominal pain and elevated lipase levels — that can diagnose acute pancreatitis, with two of the three necessary for a diagnosis.
Researcher Ying M. Tang, MD, resident at the University of Medicine and Dentistry of New Jersey, told Healio.com that ongoing study will evaluate guideline adherence in other settings. “This was done in a large, private hospital; now I’m going to do the second stage in academic centers to see if there is different compliance with the guidelines. There are some concerns that [clinicians] are getting imaging just to prove that patients don’t have severe scenarios, such as pancreatic necrosis. … People are getting unnecessary imaging, which [creates] an extra burden for X-ray exposure and medical care expense.”
For more information:
Tang YM. P669: Are Clinicians Following the ACG or ACR Guidelines When Suspecting Acute Pancreatitis? Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.