A randomized controlled trial of home monitoring versus hospitalization for mild non-alcoholic acute interstitial pancreatitis: a pilot study.
OBJECTIVE
Acute pancreatitis (AP) is a disease typically requiring in-hospital treatment. We conducted a trial to assess the feasibility of early discharge from the hospital for patients with mild non-alcoholic acute pancreatitis (NAAP).


METHODS
Eighty-four patients with mild NAAP were randomized to home or hospital groups after a short hospital stay (≤24 h). AP was defined by the revised Atlanta criteria. Mild AP was defined as an Imrie score≤5 and a harmless acute pancreatitis score (HAPS)≤2 in the first 24-h of presentation. A nurse visited all patients in the home group on the 2nd, 3rd and 5th days. All patients presented for follow-up in clinic on the 7th, 14th, and 30th days. The primary outcome was the time to resolution of pain. Secondary outcomes evaluated included time to resumption of an oral diet, 30 day hospital readmission rate as well as the total costs associated with either approach to care.


RESULTS
There was no difference between the groups with regards to demographics, prognostic severity scores, symptoms, and biliary findings. No patients developed organ failure, pancreatic necrosis, or died in either group. Time to the resolution of pain and resumption of solid food intake were similar. Three (3.6%) patients required readmission within 30 days, 1 from home and 2 from the hospital groups. The total cost was significantly less in home group ($139 ± 73 vs. $951 ± 715,p < 0.001).


CONCLUSIONS
Mild NAAP can be safely treated at home with regular visits by a nurse under the supervision of a physician. Widespread adoption of this practice may result in large cost savings.
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Ali Tüzün
AT
Ince
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey. Electronic address: drhakansenturk@yahoo.com.
Hakan
H
Senturk
Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Vikesh K
VK
Singh
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Kemal
K
Yildiz
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Ahmet
A
Danalioğlu
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Ahmet
A
Cinar
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Omer
O
Uysal
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Orhan
O
Kocaman
Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
Birol
B
Baysal
Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Ahmet
A
Gürakar
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000628:therapy*; D010359:Patient Readmission; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Acute interstitial pancreatitis; Home monitoring; Home therapy; Mild acute pancreatitis