title: A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis.
abstract: OBJECTIVE
  This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer.
  
  
  METHODS
  A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis.
  
  
  RESULTS
  There were 71,035 discharges for AP, with 1657 (2.3%) patient transfers. Transferred patients had more multisystem OF (5.6% vs 1.2%), need for ICU (22.8% vs 4.3%), MV (13.1% vs 1.4%), hemodialysis (4.2% vs 2.7%), and higher mortality (6.1% vs 1.1%) compared with nontransferred patients (P < 0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the nontransferred patients (OR, 1.37; 95% confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P < 0.0001).
  
  
  CONCLUSIONS
  Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP.
authors: From the *Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA; and †Division of Gastroenterology, Department of Medicine, ‡Pancreatitis Center, and §Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Gobind
authors: G
authors: Anand
authors: Susan M
authors: SM
authors: Hutfless
authors: Venkata S
authors: VS
authors: Akshintala
authors: Mouen A
authors: MA
authors: Khashab
authors: Anne Marie
authors: AM
authors: Lennon
authors: Martin A
authors: MA
authors: Makary
authors: Kenzo
authors: K
authors: Hirose
authors: Dana K
authors: DK
authors: Andersen
authors: Anthony N
authors: AN
authors: Kalloo
authors: Vikesh K
authors: VK
authors: Singh
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D003657:Decision Making; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D017057:Medically Uninsured; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy; D010195:Pancreatitis / Q000150:complications / Q000401:mortality*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D063728:Secondary Care Centers / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000706:statistics & numerical data