Nikitha Vobugari, MD1, Jayachidambaram Ambalavanan, MBBS1, Nadim G. Haddad, MD2, Sandeep Nadella, MBBS3; 1MedStar Washington Hospital Center, Washington, DC; 2MedStar Georgetown University Hospital, Potomac, MD; 3MedStar Georgetown University Hospital, Washington, DC
Introduction: Chronic pancreatitis (CP) is an irreversible and progressive fibro-inflammatory disease of the pancreas causing pain and/or loss of exocrine/endocrine function. It is typically diagnosed with a combination of clinical and imaging criteria including atrophy, ductal dilatation, multiple parenchymal and intraductal calcifications. One of the main challenges in making a diagnosis of CP is the lack of universally agreed gold standard diagnostic criteria. To better understand the diagnostic patterns of this chronic, often disabling illness, we performed a retrospective analysis of 215 patients with CP treated at 9 hospitals of MedStar Health Methods: Using ICD 10 codes, we retrieved charts of patients presenting to acute care sites within the MedStar Health system between March 2015 - June 2019. These included emergency room visits and inpatient admissions. The following 7 variables pertaining to diagnosis of CP were manually extracted: 1. How was CP diagnosed? 2. Who made the diagnosis? 3. Demographics including sex, age 4. Length of stay 5. Was a GI consult obtained? 6. Location of care (Tertiary care vs. Non-tertiary care hospital) 7. Presumed etiology. Statistical analysis was performed by ANOVA analysis using GraphPad PRISM for Mac OS (Version 8). Results: We found 215 encounters eligible for retrospective chart review. Average length of stay (in days) was longest when a gastroenterologist made the diagnosis (7.48), followed by the internist (2.02), or when a prior diagnosis was known (1.35). When a gastroenterologist was consulted, the chance of making an accurate diagnosis of CP was highest (53%) vs. when they weren’t consulted (20%). Most patients received a diagnosis of CP at a non-tertiary care center. The specialist making the diagnosis significantly changed the probability of accurate diagnosis (P < 0.0001) by clinical and imaging criteria. Discussion: Most patients with CP are diagnosed at non-tertiary centers within the MedStar Health System. Most of these patients are given a diagnosis based on a prior diagnosis of CP. Accuracy of diagnosis significantly improved when a gastroenterologist was consulted. Non-tertiary centers most commonly made a diagnosis of CP based on inappropriate clinical and imaging criteria. These represent avenues for targeted interventions to standardize the diagnosis of CP across a large health management organization.
Retrospective study design
Disclosures: Nikitha Vobugari indicated no relevant financial relationships. Jayachidambaram Ambalavanan indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.