{
  "abstract": "Acute pancreatitis (AP) in children and young people (CYP) is a rare disease occurring in less than 1 per 100,000. This presents challenges in ensuring an accurate diagnosis of AP is made and considered. Responding to pain in a timely manner and monitoring pain levels remains a challenge in the paediatric population. We evaluated the pain management of patients presenting with AP to our tertiary children’s hospital.Elevated lipase results were identified through our trusts biochemistry laboratory between September 2022 to June 2024 in CYP less than 18 years old. Electronic patient records were reviewed, and patient-episodes identified that meet NASPGHAN1 diagnostic criteria for AP (2 or more: abdominal pain consistent with AP, serum lipase levels 3 times greater than the upper limit of normal, or imaging consistent with AP). Episodes of AP were excluded if notes were incomplete, managed by adult gastroenterology, died due to other medical causes or remains a current inpatient.967 episodes of elevated lipase levels were identified. 60 episodes met criteria for inclusion. Age ranged 2–16 years [average 12 years]. Diagnoses: idiopathic [13], mumps [1], gallstone (GS) pancreatitis [13], acute recurrent pancreatitis (ARP) [11], SPINK1 mutation [1], PRSS1 mutation [1], propionic academic (PA) [5], methylmalonic academia (MMA) [5], azathioprine-induced [3], chemotherapy-induced (PEG-asparaginase) [14], post-operative complication [2] and post-ERCP [1]. 7 patients required an inpatient cholecystectomy, and 2 patient-episodes of GS pancreatitis required inpatient ERCP.Imaging included abdominal US [51], CT [18] and MRCP [20]. 17 patient-episodes were NBM, 37 received intravenous fluids and 15 received parenteral nutrition. 30 patient-episodes received intravenous antibiotics.17 patient-episodes were managed with enteral analgesia (paracetamol and oramorph/oxycodone) with an average length of stay of 9 days [1–51 days]. 18 patient-episodes escalated to IV analgesia with an average length of stay of 18 days [2–100 days]. 25 patient-episodes required escalation to opioid infusions with an average length of stay of 28 days [3–239 days]; chemotherapy-induced [8], MMA [1], PA [3], GS-pancreatitis [7], idiopathic [1], post-operative complication [1], ARP [3] and SPINK1 [1]. 5 patient-episodes required paediatric critical care (PCC) for pain management: GS-pancreatitis [2], chemotherapy-induced [1], PA [1] and idiopathic [1].The average length of stay was 9 days [1–239 days]. Patients that underwent cholecystectomy [7] remained an inpatient for an average of 12 days [5–51 days]. Patient-episodes with a length of stay >10 days included: idiopathic [3], mumps [1], GS-pancreatitis [6], post-operative complication [2], ARP [2], PA [2] and chemotherapy-induced [10]. Complications included 4 patient-episodes of necrotising pancreatitis; idiopathic [2], GS-pancreatitis [1] and chemotherapy-induced [1]. 3 required escalation to PCC.Active management of pain is important in the patient journey. 42% of our patient-episodes required escalation of analgesia to opioid infusions suggesting that earlier intervention with specialist support from the acute pain service will improve pain management and potentially shorten the length of stay. Following this review, we are creating a flow chart to streamline analgesia escalation and provide education and training to members of staff looking after CYP with AP.Reference Grover AS, Freeman AJ, Abu-El-Haija M, Eisses JF, Gardner TB, Liu QY, Lowe ME, Nathan JD, Palermo TM, Singh VK, Trout AT, Uc A, Husain SZ, Morinville VD. Updates in pediatric pancreatology: proceedings of the north American society for pediatric gastroenterology, hepatology, and nutrition frontiers in pediatric pancreatology symposium. J Pediatr Gastroenterol Nutr. 2019 Feb;68(2):e27-e33. doi: 10.1097/MPG.0000000000002186. PMID: 30888340; PMCID: PMC6444930.",
  "authors": [
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Gillian Rivlin"
    },
    {
      "affiliations": [
        "Leeds Medical School"
      ],
      "name": "Jake Hadden"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Loveday Jago"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Chai Lee"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Virginia Chatzidaki"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Sian Copley"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Tim Morris"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Adnaan Kala"
    }
  ],
  "title": "OC10 Analgesia in acute paediatric pancreatitis",
  "uid": "a84a29a0-db02-5b22-a827-5d6d21c7fb11"
}