Rising demand for intensive care in pediatric pancreatitis without an increase of case numbers or disease severity: a 16-year retrospective single-center cohort study

Abstract Background Between May 2024 and November 2025 eight children with pancreatitis were treated at our pediatric intensive care unit, seven of them because of the pancreatitis itself. We reviewed all pediatric pancreatitis admissions to our center from 2010 to 2025 in order to clarify whether a trend of case numbers, etiology or severity explains this clustering. Methods All inpatients under 18 years with an ICD-10 code K85–K87 were identified by a search of our central clinical controlling and reviewed based on the INSPPIRE definitions. An episode required lipase or amylase at least three times the contemporaneous upper limit of normal or diagnostic imaging, together with a compatible presentation. Exclusion criteria included, among others, conditions involving exocrine pancreatic insufficiency, such as cystic fibrosis, or patients on follow-up visits. Severity was graded according to the NASPGHAN classification. Results Of 184 identified admissions, 59 patients met the inclusion criteria: 44 acute, 7 acute recurrent and 8 chronic pancreatitis. Median age was 12 years (IQR 8–16), median stay 7 days (IQR 3–12). Biliary disease and inflammatory bowel disease were the most frequent etiologies with 10 patients each, followed by trauma and genetic variants with 7 each; 4 remained unexplained. The index episode was mild in 26 patients, moderately severe in 25, severe in 5 and could not be graded in 3. 15 patients were treated at an intensive care unit, in 9 of them the pancreatitis was the leading reason. 7 of these 9 admissions occurred in 2024–2025, one each in 2011 and 2014 and none in the nine years in between. The annual number of treated patients did not increase (10 in 2024–2025 versus 49 before), and the proportion of severe disease did not either (1/10 versus 4/49). Conclusions Case numbers and severity distribution remained stable over 16 years while the need for intensive care rose markedly in the last two years. Referral of complicated cases after advanced pediatric endoscopy became available locally in 2020 and a lower admission threshold are more plausible explanations than a change of the disease. A perceived local increase of severe pediatric pancreatitis should be checked against the complete case series of the center before it is reported as an epidemiological observation.