Pattern of Diagnostic Evaluation for the Causes of Pediatric Acute Liver Failure: An Opportunity for Quality Improvement

被引:88
作者
Narkewicz, Michael R. [1 ,2 ]
Olio, Dominic Dell [3 ]
Karpen, Saul J. [4 ]
Murray, Karen F. [5 ,6 ]
Schwarz, Kathy [7 ]
Yazigi, Nada [8 ]
Zhang, Song [9 ]
Belle, Steven H. [9 ]
Squires, Robert H. [10 ]
机构
[1] Univ Colorado Denver, Sch Med, Dept Pediat, Sect Pediat Gastroenterol Hepatol & Nutr, Aurora, CO 80045 USA
[2] Childrens Hosp, Pediat Liver Ctr, Aurora, CO USA
[3] Birmingham Childrens Hosp, Birmingham, W Midlands, England
[4] Baylor Coll Med, Dept Pediat, Div Gastroenterol Hepatol & Nutr, Houston, TX 77030 USA
[5] Seattle Childrens, Dept Pediat, Div Gastroenterol Hepatol & Nutr, Seattle, WA USA
[6] Univ Washington, Sch Med, Seattle, WA USA
[7] Johns Hopkins Med Inst, Dept Pediat, Sect Pediat Gastroenterol Hepatol & Nutr, Baltimore, MD 21205 USA
[8] Cincinnati Childrens Hosp & Med Ctr, Dept Pediat, Div Gastroenterol Hepatol & Nutr, Cincinnati, OH USA
[9] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA
[10] Childrens Hosp Pittsburgh, Dept Pediat, Div Gastroenterol Hepatol & Nutr, Pittsburgh, PA USA
关键词
D O I
10.1016/j.jpeds.2009.06.005
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective To describe the frequency of diagnostic testing for the 4 most common causes of pediatric acute liver failure (PALF) (drugs, metabolic disease, autoimmune process, and infections) in indeterminate PALF within the PALF Study Group Database. Study design PALF was defined by severe hepatic dysfunction within 8 weeks of onset of illness, with no known underlying chronic liver disease in patients from birth through 17 years of age. Results Of the 703 patients in the database, 329 (47%) had indeterminate PALF. In this group, a drug history was obtained in 325 (99%) urine toxicology screenings performed in 118 (36%) and acetaminophen level measured in 124 (38%) patients. No testing for common metabolic diseases was done in 179 (54%) patients. Anti-nuclear antibody, anti-smooth muscle antibody, and anti-liver kidney microsomal autoantibodies associated with autoimmunity were determined in 239 (73%), 233 (71%), and 208 (63%) patients, and no tests were obtained in 70 (21%). Testing was performed for hepatitis A virus, hepatitis B virus, and Epstein Barr virus in 80%, 86%, and 68%, respectively. Conclusions Current practice indicates that investigation for metabolic and autoimmune causes of PALF are infrequent in patients ultimately given a diagnosis of indeterminate acute liver failure. This offers an opportunity to improve diagnosis and potential treatment options in children with acute liver failure.
引用
收藏
页码:801 / U257
页数:7
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