Original articlePancreas, biliary tract, and liverA Learning Collaborative Approach Increases Specificity of Diagnosis of Acute Liver Failure in Pediatric Patients
Section snippets
Materials and Methods
This observational cohort study was conducted by the PALF study group funded by the National Institute of Diabetes and Digestive and Kidney Diseases (UO1-DK072146). Patients <18 years of age were eligible for enrollment if they met the following criteria: (1) no prior evidence of chronic liver disease, (2) biochemical evidence of acute liver injury, and (3) hepatic insufficiency characterized by prothrombin time ≥20 seconds or international normalized ratio ≥2.0 (not correctable with vitamin K)
Results
Twenty-four sites in the PALF consortium enrolled participants in at least 1 phase and 10 participated in all 3 phases (Supplementary Table 2). Demographic, diagnostic, and laboratory data in the overall PALF cohort (n = 1144) and the 10-site subcohort (n = 658; P1 + P2 [n = 515] and P3 [n = 143]) are reported (Table 1). P3 participants were younger, more likely to be male, and had similar total bilirubin and alanine aminotransferase levels as those in combined P1 and P2. Differences in
Discussion
Using principles of collaborative learning, PALF investigators implemented recommendations that impacted diagnostic testing, final diagnosis, and outcome.7, 8 Following integration of AS-DT into admission EMR-based order sets, diagnostic testing increased and percentage of participants with specified diagnosis increased, whereas percentage of both indeterminate diagnosis and LT decreased. LT use was reduced without increasing mortality. These efforts affirm the report from the Institute of
Acknowledgments
Key individuals who have actively participated in the PALF studies by site are listed next. Current Sites, Principal Investigators and Coordinators: Robert H. Squires, MD, Kathryn Bukauskas, RN, CCRC, Madeline Schulte, RN, BSN, Clinical Research Coordinator (Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania); Michael R. Narkewicz, MD, Michelle Hite, MA, CCRC (Children's Hospital Colorado, Aurora, Colorado); Kathleen M. Loomes, MD, Elizabeth B. Rand, MD, David Piccoli, MD,
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2022, Journal of PediatricsCitation Excerpt :The present analysis was strictly limited to genuine iPALF in infancy for which other conditions affecting the liver have been excluded. Timely selection of appropriate liver transplantation candidates with PALF has always been challenging, but it has been suggested that better delineation and refinement of possible etiologies could significantly reduce the number of unnecessary transplantation.30,31 This could be because a rapidly identified cause could be managed medically or, perhaps more importantly, because transplantation could be avoided in those who would not benefit owing to their underlying irreversible pathology.
Conflicts of interest These authors disclose the following: Phil Rosenthal has consulted for Gilead, Abbvie, Roche/Genentech, Intercept, Alexion, Retrophin, Albireo, and Audentes; received research grants from Gilead, Abbvie, BMS, and Roche/Genentech; and served on the speakers’ bureau for Retrophin. Rene Romero has consulted for Gilead. Robert H. Squires received royalties from Up-To-Date. The remaining authors disclose no conflicts.
Funding Supported by the National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Diseases, U01 DK072146).