The 1993–2003 NHAMCS ED dataset included 304,697 ED visits, of which 649 were coded as acute pancreatitis. These visits represent an estimated 2,235,000 (95%CI, 1,983,000 – 2,487,000) ED visits for "acute pancreatitis" and an overall average annual ED visit rate of 7.4 (95%CI, 6.6–8.3) per 10,000 U.S. population for the entire 11-year study period. Exclusion of sample records that were also coded as "chronic pancreatitis" and sample records with acute pancreatitis as the third-listed diagnosis left 595 visits, which are the focus of all subsequent analyses. These visits represent an estimated 2,052,000 (95%CI, 1,822,000 – 2,282,000) ED visits for acute pancreatitis and an overall rate of 6.8 (95%CI, 6.1–7.6) ED visits per 10,000 U.S. population for the entire 11-year study period. At triage, 76% (95%CI, 71–81%) were considered urgent/emergent.
Demographic characteristics of ED visits for acute pancreatitis are shown in Table 1. In brief, population rates were positively associated with age, with a significant increase at the fifth decade (age 40–49) that was relatively stable thereafter. The ED visit rate per 10,000 U.S. population among blacks (14.7; 95%CI, 11.9–17.5) was more than double that among whites (5.8; 95%CI, 5.0–6.6). Compared to all other ED visits acute pancreatitis visits were more likely to be made by males (p = 0.01). Rates did not differ by gender, urban setting, or U.S. region. Insurance status for ED visits with acute pancreatitis was similar to that of all other ED visits.
Looking at time trends over the 11-year study period, there was a significant upward trend in both the absolute numbers and the population rates for ED visits for acute pancreatitis (Figure 1; both p for trend 2), we did not observe a statistically significant increase for blacks over the 11-year time period (p = 0.24).
Analgesics were administered during 58% (95%CI, 53–63%) of ED visits for acute pancreatitis. Overall, narcotic analgesics were administered during 40% (95%CI, 35–46%) of all ED visits, so when analgesics were given they were most often narcotics. Blacks and whites were equally likely to receive analgesics (51.1% vs. 60.6%; p = 0.10). Antibiotics were administered during 9% (95%CI, 6–11%) of all visits. In terms of imaging, CT scanning or MRI were performed during 10% (95%CI, 7–13%) of visits, while ultrasound was performed 13% (95%CI, 9–17%) of the time. These numbers were too small to allow analysis of trends in imaging. Overall, 65% (95%CI, 60–69%) of ED visits for acute pancreatitis resulted in admission to the hospital.
Table 2 provides results of the multivariate logistic regression model of hospital admission. The only independent predictors of admission were older age (multivariate odds ratio of 1.5 for each increasing decade) and white race (multivariate odds ratio of 2.3). The immediacy with which the patient should be seen, as perceived at triage, had a non-significant positive association with admission. By contrast, gender, ethnicity, insurance type, urban location, and U.S. region were not associated with hospital admission.
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