Date of Award

11-23-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Howard Pearson, M.D.

Abstract

Abstract TRENDS IN PEDIATRIC ACUTE PANCREATITIS: A 12-YEAR ANALYSIS AT YALE-NEW HAVEN HOSPITAL. Alexander J. Park1, Sahibzada U. Latif2, Steven L. Werlin3, Allen Hsiao1, Dinesh S. Pashankar1, Vineet Bhandari1, Anil B. Nagar4, Sohail Z. Husain1. Departments of 1Pediatrics, Yale University, School of Medicine, New Haven, CT, 2Internal Medicine, Michigan State University, East Lansing, MI, 3Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 4Internal Medicine, Yale University, School of Medicine, New Haven, CT. Acute pancreatitis is a painful inflammatory disorder known to occur in children. Recent reports, primarily based on adult data, suggest an increasing incidence. However, pediatric studies are limited. We posit that the frequency of disease has also increased among children in the last decade. This is most likely due to one or more trends in etiologies, referral patterns for tertiary pediatric care, and/or rising obesity in children. To assess this hypothesis, a retrospective chart review spanning the last 12 years was conducted at Yale-New Haven Childrens Hospital (YNHCH). Presentation and management of pediatric pancreatitis was also assessed for the time period. ICD-9 codes were used to electronically identify admissions for acute pancreatitis at YNHCH between 1994 and 2007. Charts were obtained and cases were subjected to inclusion criteria for acute pancreatitis. 594 cases were identified by ICD-9 codes, of which 271 fulfilled inclusion criteria. Mean age was 13.1 ± 5.6 years (yr). Over the last decade (between 1995-2000 and 2001-2006), frequency of acute pancreatitis increased 53% (16¬±3.35 cases/yr to 23.5±5.5 cases/yr, P<0.02). The most common etiologies for pancreatitis over time were idiopathic, medications, and biliary disease. These did not change in a statistically significant manner to account for the rising frequency of disease. Median body-mass-index (BMI) percentile increased from 50 to 58.9 (P=0.85) but was nonsignificant. Frequency of disease was normalized by total annual pediatric Emergency Department visits to YNHCH over the study period in order to analyze the effect of referral bias. This reduced the increase in pancreatitis to 22% and rendered the trend nonsignificant (P=0.16). This is the first report in the field to demonstrate that acute pancreatitis in children may be rising in part due to growing referrals to tertiary care centers. It is also the first to assess the role of BMI in pediatric pancreatitis from an epidemiologic perspective.

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