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179 THE INCREASING RATE OF PEDIATRIC ACUTE PANCREATITIS: EXPERIENCE AT THE CHILDREN'S HOSPITAL OF PITTSBURGH BETWEEN 1993 AND 2004 V Morinville1,3, S Forget3, ME Lowe2 BACKGROUND: Multiple studies show an increase in acute pancreatitis (AP) incidence for adults over the past four decades. Pediatric data are sparse, with only one series based on year of diagnosis (Lopez, J Pediatr 2002). There is uncertainty whether pediatric AP incidence is truly increasing or if the increase results from increased awareness leading to more amylase and lipase testing or from an increased pediatric population.
Divisions of 1Gastroenterology, Hepatology and Nutrition; 2Pediatric Gastroenterology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of 3Pediatric Gastroenterology and Nutrition, McGill University, Montreal, Quebec
METHODS: This study consisted of a retrospective review of total inpatient AP cases diagnosed at a university-affiliated tertiary care pediatric hospital between 1993 to 2004. The ICD-9 code 5770 acute pancreatitis was used; results were tabulated by month and year at discharge. Total amylase and lipase tests were reviewed for the corresponding years. Total pediatric catchment population for 23 surrounding counties was obtained for the years 1993 through 2004. Trends were compared.
RESULTS: There were a total of 1021 discharge diagnoses of AP made. A general increasing trend was observed. The absolute number of cases was lowest in 1993 and highest in 2004 (28 versus 141 cases, a 500% increase). No seasonal variation occurred. There was an increasing trend for pancreatic enzyme testing: from a low of 3321 (in 1995; 5428 tests in1993) to a high of 8621 (2004) for amylase, and a low of 2612 (1993) to a high of 7569 (2004) for lipase (increases of 260% and 290%, respectively). The catchment population for the hospital decreased from 882,000 to 826,500 children (6.3% decrease).
CONCLUSIONS: Acute Pancreatitis was increasingly listed as discharge diagnosis at the Children's Hospital of Pittsburgh between the years 1993 and 2004, a time period during which underlying catchment population decreased. The reason for the escalation in diagnosing AP cannot be explained by an increased rate of pancreatic enzyme testing alone, although the possibility of this or other factors acting in an additive fashion has not been studied. Our findings support the impression of numerous clinicians that the rate of pediatric acute pancreatitis cases is increasing.