The Liverpool alcohol‐related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England. Issue 4 (17th November 2022)

• Record Type: Journal Article
• Authors: Dhanda, Ashwin; Bodger, Keith; Hood, Steve; Henn, Clive; Allison, Michael; Amasiatu, Chioma; Burton, Robyn; Cramp, Matthew; Forrest, Ewan; Khetani, Meetal; MacGilchrist, Alastair; Masson, Steven; Parker, Richard; Sheron, Nick; Simpson, Ken; Vergis, Nikhil; White, Martin
• Other Names: Saleh Ahmed investigator.; Boyd Alex investigator.; Brind Alison investigator.; Joshi Alka investigator.; Rund Angie investigator.; Srivastava Ankur investigator.; McCune Anne investigator.; Gartland Anthony investigator.; Hudson Ben investigator.; Stableforth Bill investigator.; John Christopher investigator.; Maxan Ema investigator.; Unitt Esther investigator.; Beetteridge Frederica investigator.; Lewis Heather investigator.; Fellows Helen investigator.; Haq Ihteshamul investigator.; Patel Janisha investigator.; Ryan Jennifer investigator.; Cobbold Jeremy investigator.; Pohl Keith investigator.; Raeburn Kevin investigator.; Corless Lynsey investigator.; Johnston Michael investigator.; Subhani Mohsen investigator.; Shah Naina investigator.; Ali Nasima investigator.; Rajoriya Neil investigator.; Bendall Olly investigator.; Saeed Omar investigator.; Berry Philip investigator.; Moodley Prebashan investigator.; Abdelbadiee Sherif investigator.; Davies Sian investigator.; Kotha Sreelakshmi investigator.; Ryder Steve investigator.; Verma Sumita investigator.; Manship Tom investigator.; Kumar Vinay investigator.; Haddadin Yazan investigator.;
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 57:Issue 4(2023)
• Page Start: 368
• Page End: 377
• Publication Date: 2022-11-17
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.17307
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Emergency admissions in England for alcohol‐related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD‐specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations. Aim: To deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns ( e.g., ArLD secondary diagnosis with alcohol/liver‐related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID‐19 pandemic. Methods: We applied the standard approach and LAA to Hospital Episode Statistics for England (2013–21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7‐day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data. Results: Nationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD‐specific admissions increased by 30.4%. Of 39, 667 admissions in 2020/21, only 19, 949 were identified with standard approach, an estimated admission cost of £70 million in under‐recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven‐day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis. Conclusions: The LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long‐term rise in ArLD admissions and mortality. Abstract : The Liverpool alcohol‐related liver disease algorithm identifies double the number of emergency hospital admissions compared to standard methods when applied to English Hospital Episode Statistics.