AN AUDIT OF FATAL ACUTE-PANCREATITIS

Acute pancreatitis has a mortality of about 10%: this figure has not c hanged over the last 20 years. A retrospective audit of fatal acute pa ncreatitis was performed in a teaching hospital with a catchment popul ation of about 750 000 patients to examine patient charactistics. Usin g Hospital Activity Analysis code 577.0, all fatal cases of acute panc reatitis were studied in a six-year period 1987-93. Additionally, all post mortem diagnoses of acute pancreatitis were traced. The overall p ost mortem rate in Nottingham at the time of the study was about 35%. All available records, X-ray and biochemical data were studied and app ropriate information recorded and analysed for 65 fatal cases. Only 15 % were post mortem diagnoses, lower than in previous series; 72% had r espiratory and 67% had renal complications. Only 34% had been admitted to the intensive care unit. A third of patients had had surgery; 67% of these was some form of external drainage. Of the 14 patients with p roven gallstone pancreatitis only three had endoscopic retrograde chol angiopancreatography; 42% of patients had idiopathic disease. Not all the patients diagnosed ante mortem had the full biochemical predicted severity criteria analysed: pO(2) and calcium analysis was performed i n about 80%. Premortem diagnoses of pancreatitis was achieved more fre quently than in other comparable series.