O82: SCORPION: SCOPING OUTCOMES FOR ACUTE PANCREATITIS: A NATIONWIDE STUDY

  Presenting Author Email: siveshkk93@gmail.com Research question 1. What is the compliance to audit standards to British Society of Gastroenterology (BSG) guidelines for the management of patients with acute pancreatitis across hospitals in the United Kingdom and Republic of Ireland? 2. What factors are associated with positive clinical and patient-reported outcomes associated with acute pancreatitis at one-year following the index admission? 3. What is the external validity of common risk prediction scores in the revised Atlanta classification of acute pancreatitis, specifically severe acute pancreatitis? 4. Does centralisation of acute severe pancreatitis services improve clinical outcomes? Background and aim Acute pancreatitis is a common surgical emergency in the UK, with rising incidence estimated to 15 - 42 cases per 105/year reported.1 The revised Atlanta 2012 classification details spectrum of AP from a mild self-limiting attack to severe illness resulting in significant local and systemic complications and even death.2,3 Previous audits have identified wide variations in practice across the UK,4-8 with varied compliance to contemporaneous practice guidelines.9,10 However, these audits have been limited to retrospective, small studies and lack established snapshot of national practices from a contemporary cohort. An evaluation of current practice and compliance with up-to-date guidelines may be expected to identify areas for care improvement on a national level. Therefore, the aims of this study were to prospectively evaluate the contemporary management of acute pancreatitis nationally across the UK and Republic of Ireland and compare with guideline standards, and to determine the value of modern definitions in the assessment and management of a population-based sample of patients with acute pancreatitis. Design Patients Consecutive adult patients (≥16 years old) fulfilling the revised Atlanta diagnostic criteria2 of acute pancreatitis will be included. This is defined as two of either: (1) abdominal pain consistent with acute pancreatitis (acute onset of a persistent, severe, epigastric pain often radiating to the back); (2) serum lipase or amylase at least three times greater than the upper limit of normal; and (3) characteristic findings of acute pancreatitis on imaging. Patients with chronic pancreatitis but no evidence of acute inflammation on imaging will be excluded. Intervention / Comparator: Patients will be compared by the severity of pancreatitis defined by the revised Atlanta diagnostic criteria2 (mild vs moderate vs severe). Data will be collected on audit standards, and confounding factors for risk of acute pancreatitis to permit accurate risk adjustment of outcomes. Without appropriately adjusting for risk factors, it is likely that any findings would be biased and unable to be appropriately analysed on a national scale. Outcomes: Primary outcome: Adherence to selected British Society of Gastroenterology (BSG) guidelines for the management of patients with acute pancreatitis (percentage, %). These will include: • Overall mortality should be <10% (<30% in severe pancreatitis). • Aetiology should be determined in ≥80% of cases. • Severity stratification should be made within 48 hours of diagnosis • All patients with biliary pancreatitis should undergo definitive management of gallstones during the same hospital admission (unless definitive treatment planned within two weeks). • Dynamic CT in severe cases (within 6–10 days of presentation) • Definitive treatment of gallstone pancreatitis (within 2 weeks of index admission) • Urgent ERCP for severe gallstone pancreatitis • HDU or ITU care for severe cases Secondary outcomes • Health-related quality of life as assessed using the externally validated SF-36 questionnaires and Pancreatitis Quality of Life Instrument (PANQOLI) at baseline, and 1, 3, 6, and 12 months. • Length of in-patient stay. • Timing and mode of feeding • Rates of prophylactic antibiotic use in severe acute pancreatitis Study Design SCORPION will be a prospective multi-centre prospective audit and cohort study open to all hospitals in the United Kingdom and the Republic of Ireland which routinely manage acute pancreatitis. Consecutive adult patients presenting with acute pancreatitis from February 2021 - April 2021 in hospitals in the United Kingdom and the Republic of Ireland will be included in the audit. The audit protocol will be disseminated through local and national medical student and specialty networks in the UK and Ireland. At each participating centre, mini-teams of up to 4 medical students and junior doctors will prospectively collect data over a 2-week period. All mini-teams will be supervised by a hospital lead and a consultant. SCORPION will also provide opportunities for all sites participating in the main project to take part in a “Bolt-On” research study. Ethical approval will be required for all centres wishing to participate in the bolt-on study, with both a Principal Investigator (PI) and associate PI at each of these sites. The patients included in the audit will form the eligible population, and informed consent will be required for inclusion in the cohort study. These patients will receive patient-reported outcome surveys (SF-36 and PANQOLI) at admission and at defined follow-up intervals (1, 3, 6, 12 months following discharge). This will be via automated smartphone follow-up using via on online Research Electronic Data Capture (REDCap) survey through the use of Twilio. Team and infrastructure STARSurg is a student-led, national collaborative empowering students and junior doctors to conduct high-quality, multicentre, protocol-driven audit and research. To date, STARSurg has delivered six national audits of perioperative care,11-16 engaging 7,500 collaborators from 180 centres (UK and Ireland), collecting data on 32,000 patients and resulted in 19 peer-reviewed publications in high-impact journals. The steering committee will work closely with cross-speciality experts and patient representatives across the UK and Ireland to design and deliver this proposal. Medical students lead local delivery of this study alongside junior doctors and supervising consultants using our established and validated “mini-team” model. All collaborators will complete mandatory training via elearning modules on acute pancreatitis and data governance. Bolt-on participants will be required to complete NIHR Learn modules on both Good Clinical Practice, and the Generating Student Recruiters for Randomised Trials (GRANULE) course17 (co-developed by STARSurg).