Authors: Dr. Mostafa Alhabboubi , Dr. Laurie Robichaud , Dr. Seth Davis , Dr. Paul Brisebois , Dr. Jerome Williams , Dr. Shannon Fraser , Dr. Alex Guttman , Ms. Xiaoqing Xue , Marc Afilalo , Dr. Eli Segal

Abstract

Background:
Early abdominal CT is often performed for acute pancreatitis (AP) in the emergency department (ED), despite guidelines recommending delayed imaging unless diagnosis is uncertain or deterioration occurs after 48–72 h. Excess imaging may prolong ED length of stay (LOS) without improving outcomes. We evaluated whether implementing an ED admission protocol for AP reduced CT use and ED LOS.

Methods:
We conducted a retrospective pre–post study at a university-affiliated ED. Adults with AP were included from two periods: pre-protocol (Feb 2019–Feb 2021) and post-protocol (Apr 2021–Jan 2023). Primary outcomes were proportion receiving CT before admission and ED LOS. Secondary outcomes included CT ordering service, ultrasound use, complications, and mortality.

Results:
A total of 458 visits were analyzed (210 pre-, 248 post-protocol). Overall CT use was unchanged (88.5 % vs 85.5 %, p = 0.40). CTs ordered by ED clinicians decreased (97.8 % to 91.9 %; p = 0.037), while those by surgery increased (2.1 % to 7.4 %; p = 0.037). Mean ED LOS was similar (20.4 h vs 21.3 h; p = 0.56). Post-protocol, point-of-care ultrasound (PoCUS) use rose (48.1 % to 53.2 %) and gallstone detection improved (26.5 % to 36.1 %, p = 0.001). Complication rates (9.7 % vs 8.6 %) and mortality (2.2 % vs 2.8 %) were unchanged. Only 11.1 % of CTs revealed any abnormality, and 5.9 % were pancreas-specific.

Conclusions:
A standardized protocol did not significantly reduce CT use or ED LOS but shifted ordering patterns and increased PoCUS utilization. Future work should target predictors for early imaging and strategies to enhance protocol adherence.

Keywords: Acute pancreatitis, CT scan, Admission protocol, Point of Care Ultrasound