Treatment of Mild Exacerbations of Recurrent Alcoholic Pancreatitis in an Emergency Department Observation Unit

Patients with mild exacerbations of recurrent alcoholic pancreatitis are occasionally treated in the emergency department observation unit with parenteral hydration and analgesia in hopes of avoiding hospitalization. To determine whether such treatment is efficacious and cost-effective, we reviewed 27 consecutive admissions to the emergency department observation unit for exacerbation of previously documented recurrent alcoholic pancreatitis. For comparison, we studied 27 randomly selected, matched patients admitted directly to the hospital. Of the 27 admitted to the observation unit, 14 (52%) improved sufficiently for discharge in less than 24 hours (group A; mean duration of observation, 14.4 hours); the other 13 (48%) required continued hospitalization (group B; average length of stay, 7.5 days). The group admitted directly to the hospital (group C) had a mean stay of 5.8 days (difference not significant). Of a variety of parameters compared, only serum amylase values differed significantly between the three groups. A serum amylase cutoff of 300 U/dl would have correctly identified all patients in group A (sensitivity 100%), though with a relatively low specificity (60%). We conclude that there may be a subset of patients with mild exacerbation of recurrent alcoholic pancreatitis, identifiable by a low serum amylase level, who would benefit from a trial of management in an emergency department observation unit.