High early mortality rate from acute pancreatitis in Scotland, 1984-1995

Background: Death from acute pancreatitis within the first week after admis sion is usually a consequence of multiple organ dysfunction. Reports from s pecialist centres suggest that, with improvements in resuscitation and supp ortive care, such deaths are becoming uncommon but it is unclear if this is reflected in a decrease in early mortality rate from acute pancreatitis in the general population, Methods: Data concerning patients discharged with a diagnosis of acute panc reatitis (International Classification of Disease-9 code 577.0) between 198 4 and 1995 were obtained from the Information and Statistics Division, Nati onal Health Service in Scotland, and anal, sed on a computer database. Results: The incidence of acute pancreatitis in Scotland continues to incre ase in both sexes, The in-hospital mortality rate (death from all causes) w as 7.5 per cent and showed a slight but significant downward trend over the period of study. Death within 7 days of hospital admission accounted for 5 3.7 per cent of all deaths and the proportion of early deaths did not decli ne over the study interval. Conclusion: These results suggest that scope remains for considerable impro vement in the early management of acute pancreatitis. There is an urgent ne ed to improve the early recognition of severe pancreatitis coupled to a wil lingness on behalf of clinicians to transfer these patients at an early sta ge to a centre with high-dependence and intensive care facilities supervise d by a multidisciplinary team with expertise in the endoscopic, radiologica l and surgical management of these patients.