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University Surgical
Unit (816), Southampton General Hospital, Tremona Rd, Southampton,
Hampshire SO16 6YD, UK
Correspondence to: Mr Johnson.
Accepted for publication 9 September 1999
BACKGROUND
The incidence of acute
pancreatitis shows regional variations in the UK.
AIMS
To document the incidence and
presentation of acute pancreatitis in hospitals in Wessex, and to audit
the process and outcome of management of patients against the UK guidelines.
METHODS
A prospective survey was
carried out of all patients with acute pancreatitis in a one year
period, in eight geographically adjacent acute hospitals in the Wessex region.
RESULTS
186 patients with acute
pancreatitis were identified, an incidence of 152 per million in the
adult population. Aetiology was: gallstones 33%, alcohol 20%,
idiopathic 32%, other 15%. There were 60 severe cases with 17 deaths.
Age and APACHE-II score had significant relations to outcome, but delay
to admission, serum amylase level, aetiology, and sex did not. The
mortality rate (9.1%) was within the audit standard of 10%. Some
management goals were not met: in mild cases, only one third of
patients with gallstone pancreatitis had definitive treatment within
four weeks. In severe cases, there was poor use of objective severity
stratification (19%), low admission rates to a high dependency unit or
intensive care unit (67%), and only 33% of patients had computed
tomography. Only seven of 17 patients with severe gallstone
pancreatitis had an urgent endoscopic retrograde cholangiopancreatography.
CONCLUSIONS
The incidence of
clinically diagnosed acute pancreatitis in England continues to rise.
Current management of acute pancreatitis is suboptimal when compared
with evidence based UK guidelines but the mortality rate was within the
guideline standard.
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