Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 107

There is very little data that can be used to assess which patients with AP can safely be discharged from the emergency room. Whitlock et al. [25] looked at scoring systems to predict readmission within 30 days and identified the following discharge characteristics as risk factors: inability to tolerate a solid diet, any gastrointestinal symptoms (nausea, vomiting, diarrhea), pain, pancreatic necrosis, and treatment with antibiotics. Although this is primarily for inpatient hospitalization, one could argue this could also be used in the emergency room.

It is crucial to promptly identify patients who need intensive care unit versus medical floor hospitalization and those who need subspecialist consultation. Although there are numerous scoring systems for assessing the severity of AP, most of these systems have been criticized as they require more than 48–72 hours before score parameters become evident and are therefore not very useful in the emergency room setting [26,27]. The most practical and useful evaluation includes assessment of SIRS criteria [6]. It is critical in the early phase of management to (i) determine patient‐related factors such as age and body mass index; (ii) perform a careful clinical examination; and (iii) utilize the available laboratory results to assess early fluid losses (e.g. rising blood urea nitrogen, creatinine, hematocrit), hypovolemic shock, and signs of organ dysfunction (Table 7.1).