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Clinical and Practice Variations in Pediatric Acute Recurrent or Chronic Pancreatitis: Report From The Insppire Study.

OBJECTIVE
To determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) sites.


STUDY DESIGN
Data were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson Chi-Square test. Differences in disease burden were compared by Kruskal-Wallis test.


RESULTS
Of 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (p < 0.0001); white race in Northeast (p = 0.009). CP was less common and time from diagnosis of first acute pancreatitis to CP was longer in children at non-US sites (p = 0.0002 and p = 0.011 respectively). Genetic mutations were most common among all groups; PRSS1 variants predominated in Midwest (p = 0.002). Gallstones were more frequent in South (p = 0.002). ERCP and CT imaging were more commonly utilized in US compared to non-US (p < 0.0001), but there were no differences in the use of MRI/MRCP. Disease burden was highest in the West and Midwest, possibly because total pancreatectomy and islet autotransplantation (TPIAT) referral sites were located in these regions. All therapies were less commonly administered in non-US sites (p < 0.0001).


CONCLUSION
This is the first study to describe geographical variations in the INSPPIRE cohort, which possibly reflect variations in practice and referral patterns. The underlying reason behind the lower frequency of CP and fewer treatments in non-US sites need to be further explored.