title: Study of the early management of acute pancreatitis.
abstract: BACKGROUND
  Acute pancreatitis (AP) is a common acute surgical presentation with evidence-based guidelines for early management. The aim of this study was to assess the compliance to the published guidelines in patients presenting with AP in Western Sydney.
  
  
  METHODS
  A retrospective case note audit was conducted for all patients with a confirmed diagnosis of AP from 2008 to 2011 in Western Sydney.
  
  
  RESULTS
  There were 932 patients. The mortality was low for mild (0.7%) and severe (1.2%) AP. There was an under-utilization of ultrasound (U/S) with 239 (25.6%) patients not having a U/S. There was an over-utilization of early (within 72 h) computed tomography scanning for diagnosis (31.1%), assessment of severity (16.1%) and assessment for the presence of complications (7.3%). Inappropriate prophylactic antibiotic usage occurred in 15.3% patients. Of 373 cases of gallstone pancreatitis, only 231 (69.1%) had a cholecystectomy within 4 weeks of presentation. There was an under-utilization of early endoscopic retrograde cholangiopancreatography for associated cholangitis (12.5%). Only 16 (18.8%) patients with severe pancreatitis received enteric feeding. In patients with pancreatic necrosis, 50% had invasive intervention delayed beyond 4 weeks and 69% had minimally invasive procedures performed prior to necrosectomy. Patients having a minimally invasive procedure initially showed an improvement in mortality compared with those who had primary necrosectomy (0 versus 40%, P = 0.025).
  
  
  CONCLUSIONS
  Although morbidity and mortality were acceptable, there was a failure to comply with evidence-based guidelines for the early management of pancreatitis. The results support for the development and auditing of protocols for the early assessment and treatment of AP in all hospitals.
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Maryam
authors.initials: M
authors.lastname: Nesvaderani
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Shadi
authors.initials: S
authors.lastname: Faraj
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vagg
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Cox
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002761:Cholangitis / Q000150:complications / Q000601:surgery*; D002763:Cholecystectomy / Q000379:methods; D061345:Early Medical Intervention / Q000379:methods*; D055317:Evidence-Based Practice / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015898:Tomography Scanners, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data; D055815:Young Adult
keywords: acute pancreatitis; antibiotic; early management; imaging