A331 QUALITY GAPS IN THE MANAGEMENT OF PATIENTS WITH ACUTE PANCREATITIS
Notice bibliographique
Résumé
Acute pancreatitis is the most common gastrointestinal (GI) cause for hospitalization and is associated with high morbidity and mortality. Multiple clinical guidelines outline best practices for the management of these patients. However, recent studies suggest that adherence to such guidelines is poor. In this study, we aim to audit current practice to identify potential targets for quality improvement initiatives. A retrospective chart review of all patients admitted directly to St. Michael’s Hospital (a tertiary-care hospital) from the Emergency Department with a diagnosis of acute pancreatitis between July 1, 2016 and December 31, 2016 was performed. Complex patients transferred from another hospital to the ICU or GI ward were excluded. Patients were identified using ICD-10 discharge codes. Potential quality indicators were extracted from the recent AGA, ACG and recently published Canadian guidelines on the management of acute pancreatitis. Individual charts were reviewed and the following data was extracted: laboratory values, imaging results, dates of admission and, discharge, interventions/procedures performed, antibiotic use and nutrition. The data was were then used to determine baseline characteristics and adherence to guidelines. A total of 55 patients were included in the study. The mean age was 50 (range 16 to 92) years and 31 (56%) were male. The most common cause of acute pancreatitis was idiopathic (36%), followed by alcohol (22%) and gallstones (20%). The average Charlson co-morbidity index was 2.4 (+/- 2.6). The average length of stay was 5.8 (range 1 to 46) days. 3 patients required ICU admission. Ultrasound was performed within 48 hours of admission in 28 (51%) patients, while 23 (42%) patients had a CT scan during their admission. The most common reason for CT was for diagnostic evaluation (52%), followed by investigation for underlying etiology (30%). 25% of patients did not obtain any imaging during their admission. 2 (4%) patients did not receive nutrition within 48 hours, with the average time to nutrition being 1 day. Antibiotic prophylaxis was started in 4 (7%) patients. The average fluid resuscitation rate was 113 (+/- 64) mL/hour. No patients had appropriate lab values drawn to calculate Apache or other severity index scores. Only 3 patients had CRP measured. For patients with biliary pancreatitis, 5/13 required ERCP during their admission (all for ongoing biliary obstruction), and only 36% underwent cholecystectomy within the same admission. The management of patients presenting with acute pancreatitis remains quite variable, with the most common deficiencies relating to imaging for potential etiologies, risk stratification, under resuscitation with intravenous fluids and delay to cholecystectomy. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,050 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».