A331 QUALITY GAPS IN THE MANAGEMENT OF PATIENTS WITH ACUTE PANCREATITIS
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.050 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".