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. 2023 Feb;57(4):368-377.
doi: 10.1111/apt.17307. Epub 2022 Nov 17.

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

Ashwin Dhanda  1   2 , Keith Bodger  3   4 , Steve Hood  4 , Clive Henn  5 , Michael Allison  6 , Chioma Amasiatu  5 , Robyn Burton  5 , Matthew Cramp  1   2 , Ewan Forrest  7 , Meetal Khetani  5 , Alastair MacGilchrist  8 , Steven Masson  9 , Richard Parker  10 , Nick Sheron  5 , Ken Simpson  8 , Nikhil Vergis  11   12 , Martin White  5 ; BASL ARLD SIG National Service Evaluation Group
Collaborators, Affiliations

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

Ashwin Dhanda et al. Aliment Pharmacol Ther. 2023 Feb.

Abstract

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.

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Conflict of interest statement

Richard Parker: Speaking fees from Norgine, Siemens and Shionogi, consulting fees from DURECT. Robyn Burton: Paid consultancy for the World Health Organization (2019 and 2020). Nikhil Vergis: Changed affiliation during the study from Imperial College London to GlaxoSmithKline (GSK). GSK did not have any involvement in any aspect of this study. None of the other authors have any competing interest to declare

Figures

FIGURE 1
FIGURE 1
The annual number of ArLD‐primary and ArLD‐uplift completed unplanned hospital admissions in England, 2013/14 to 2020/21.
FIGURE 2
FIGURE 2
Number of total completed hospital admissions in England (red line; data from NHS Digital 11 ) and ArLD‐primary and ‐uplift admissions (light and dark blue lines) per month determined by applying the Liverpool ArLD Algorithm to the HES dataset from August 2019 to March 2021.
FIGURE 3
FIGURE 3
Monthly trend of in‐hospital deaths of patients with ArLD from August 2019 to March 2021 using the Liverpool ArLD Algorithm applied to HES dataset.
See this image and copyright information in PMC

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References

    1. NHS Digital . Statistics on Alcohol, England 2020. NHS Digital. 2020. Accessed 10/09/2021. https://digital.nhs.uk/data‐and‐information/publications/statistical/sta...
    1. Public Health England . Monitoring alcohol consumption and harm during the COVID‐19 pandemic. London: Public Health England; 2021.
    1. Daly M, Robinson E. High‐risk drinking in midlife before versus during the COVID‐19 crisis: longitudinal evidence from the United Kingdom. Am J Prev Med. 2021;60(2):294–7. - PMC - PubMed
    1. Jackson SE, Garnett C, Shahab L, Oldham M, Brown J. Association of the COVID‐19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019‐20 data. Addiction. 2021;116(5):1233–44. - PMC - PubMed
    1. Ramrakhiani NS, Le MH, Yeo YH, Le AK, Maeda M, Nguyen MH. Validity of international classification of diseases, tenth revision, codes for cirrhosis. Dig Dis. 2021;39(3):243–6. - PMC - PubMed

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