Clinical Practice Guidelines: Acute Pancreatitis



Acute pancreatitis is an inflammatory process of the pancreas that affects 12 cases per 100,000 persons per year. Data from the Kids’ Inpatient Database reveal that pediatric admissions for pancreatitis have been increasing with an average hospitalization cost of $6,000.

Acute pancreatitis has several possible etiologies, and often multiple risk factors are involved. Most cases are are mild and recover within three to five days, but acute pancreatitis can be severe and recurrent. Recent INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a CuRE) publications define clinical criteria for defining acute, acute recurrent and chronic pancreatitis.

This clinical practice guideline (CPG) serves to detail the initial workup, appropriate disposition and treatment of cases of acute pancreatitis that follow the expected clinical course. The cornerstones of care currently focus on adequate pain control, aggressive hydration, minimizing time to reintroducing diet and unnecessary exposures to radiation and antimicrobials. More specifically, aggressive hydration and early enteral nutrition have been associated with decreased severity and length of stay. The CPG also details next steps for patients not progressing in the expected manner and involvement of consultants in such cases.

Measurable outcomes

  • Length of stay.
  • Early enteral nutrition (beyond clear liquids) within first 48hrs.
  • Use of parenteral nutrition.
  • High IVF rate (meaning 1.5x maintenance).
  • Requirement and timing of CT scan.
  • End organ failure and ICU admissions.

Acute pancreatitis guideline team

  • J. Andres Martinez, M.D. – Pediatric Gastroenterology (Contact)
  • Katie Conover, M.D. – Pediatric Resident
  • Martha Ballew, R.D., LDN, CNSC – Nutrition
  • Lauren McClain, M.D. – Pediatric Hospital Medicine
  • Jaime Kaye Otillio, M.D. – Pediatric Emergency Medicine
  • James C. Gay, M.D. – General Pediatrics
  • Beth Loats, R.N. – Nursing
  • Caroline Epps, R.N,. MSN – Quality and Safety
  • Marta Hernanz-Schulman, M.D. – Pediatric Radiology
  • Dai H. Chung, M.D. and Melissa Danko, M.D. – Pediatric General Surgery