RT Journal Article
SR Electronic
T1 Development and validation of diagnostic triage criteria for liver disease from a minimum data set enabling the ‘intelligent LFT’ pathway for the automated assessment of deranged liver enzymes
JF Frontline Gastroenterology
JO Frontline Gastroenterol
FD BMJ Publishing Group Ltd
SP flgastro-2017-100909
DO 10.1136/flgastro-2017-100909
A1 Michael Hugh Miller
A1 Andrew Fraser
A1 Gillian Leggett
A1 Alastair MacGilchrist
A1 George Gibson
A1 James Orr
A1 Ewan H Forrest
A1 Ellie Dow
A1 William Bartlett
A1 Chirstopher Weatherburn
A1 Axel Laurell
A1 Kirsty Grant
A1 Kathryn Scott
A1 Ronald Neville
A1 John F Dillon
YR 2018
UL http://fg.bmj.com/content/early/2018/02/07/flgastro-2017-100909.abstract
AB Background Liver function tests (LFTs) are commonly abnormal; most patients with ‘incidental’ abnormal LFTs are not investigated appropriately and for those who are, current care pathways are geared to find an explanation for the abnormality by a lengthy process of investigation and exclusion, with costs to the patient and to the health service.Objective To validate an intelligent automatable analysis tool (iLFT) for abnormal liver enzymes, which diagnoses common liver conditions, provides fibrosis stage and recommends managementDesign A retrospective case note review from three tertiary referral liver centres, with application of the iLFT algorithm and comparison with the clinician’s final opinion as gold standard.Results The iLFT algorithm in 91.3% of cases would have correctly recommended referral or management in primary care. In the majority of the rest of the cases, iLFT failed safe and recommended referral even when the final clinical diagnosis could have been managed in primary care. Diagnostic accuracy was achieved in 82.4% of cases, consistent with the fail-safe design of the algorithm. Two cases would have remained in primary care as per the algorithm outcome, however on clinical review had features of advanced fibrosis.Conclusion iLFT analysis of abnormal liver enzymes offers a safe and robust method of risk stratifying patients to the most appropriate care pathway as well as providing reliable diagnostic information based on a single blood draw, without repeated contacts with health services. Offers the possibility of high quality investigation and diagnosis to all patients rather than a tiny minority.