Observational studyClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2018
A Learning Collaborative Approach Increases Specificity of Diagnosis of Acute Liver Failure in Pediatric Patients.
Observational study in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed.
- Immune mechanisms and pathophysiology of T cell-mediated pediatric acute liver failure (TC-PALF).Hepatology communications · 2026Review
- The incidence, frequency of late liver-related complications, and transplant likelihood in pediatric acute liver failure in Californian children.Hepatology communications · 2026Article
- CD8 TRM-like T cells expressing perforin and IFN-γ define a pediatric activated T-cell acute liver failure endotype.Hepatology communications · 2026Article
- Paediatric acute liver failure: A prospective, nationwide, population-based surveillance study in Germany.Journal of pediatric gastroenterology and nutrition · 2025Article
- Acute Liver Failure with Determinate rather than Indeterminate Etiology Facilitates Therapy and May Avoid Liver Transplantation: A Critical Analysis.Journal of clinical and translational hepatology · 2025Review
- N-Acetylcysteine and Hemodialysis in Severe Acetaminophen Toxicity in a 15-Year-Old Adolescent: A Case Report.The American journal of case reports · 2025Article
- Initiating a paediatric living donor liver transplant program in a resource-challenged environment: outcomes and lessons learned.Pediatric surgery international · 2025Article
- Disorders of vesicular trafficking presenting with recurrent acute liver failure: NBAS, RINT1, and SCYL1 deficiency.Journal of inherited metabolic disease · 2025Review
- Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN).Hepatology international · 2024Review
- Identification of pediatric activated T-cell hepatitis using clinical immune studies.Clinics and research in hepatology and gastroenterology · 2024Article
- Deaths Associated with Pediatric Hepatitis of Unknown Etiology, United States, October 2021-June 2023.Emerging infectious diseases · 2024Article
- [Advancements in the diagnosis and treatment of pediatric acute liver failure].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2024Review
- Improved mortality prediction for pediatric acute liver failure using dynamic prediction strategy.Journal of pediatric gastroenterology and nutrition · 2024Article
- Intertwined roles for GDF-15, HMGB1, and MIG/CXCL9 in Pediatric Acute Liver Failure.Frontiers in systems biology · 2024Article
- Dynamic risk score modeling for multiple longitudinal risk factors and survival.Computational statistics & data analysis · 2024Article
- Paediatric acute hepatitis of unknown aetiology: a national surveillance investigation in the USA during 2021 and 2022.The Lancet. Child & adolescent health · 2023Review
- Adenovirus is Not Detected in Liver Tissue From a Historical Multicenter Cohort of Children With Acute Liver Failure.Journal of pediatric gastroenterology and nutrition · 2023Article
- Identifying the Aetiology of Acute Liver Failure Is Crucial to Impact Positively on Outcome.Children (Basel, Switzerland) · 2023Article
- Long-Term Survival Outcomes beyond the First Year after Liver Transplantation in Pediatric Acute Liver Failure Compared with Biliary Atresia: A Large-Volume Living Donor Liver Transplantation Single-Center Study.Journal of clinical medicine · 2022Article
- Unique hepatic manifestations of COVID-19-induced immune dysregulation in children.Clinical case reports · 2022Article
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Authors and funding
17 authors.
Funding
Abstract
BACKGROUND &
aimsMany pediatric patients with acute liver failure (PALF) do not receive a specific diagnosis (such as herpes simplex virus or Wilson disease or fatty acid oxidation defects)-they are left with an indeterminate diagnosis and are more likely to undergo liver transplantation, which is contraindicated for some disorders. Strategies to facilitate complete diagnostic testing should increase identification of specific liver diseases and might reduce liver transplantation. We investigated whether performing recommended age-specific diagnostic tests (AS-DTs) at the time of hospital admission reduces the percentage PALFs with an indeterminate diagnosis.
methodsWe performed a multinational observational cohort study of 658 PALF participants in the United States and Canada, enrolled at 10 medical centers, during 3 study phases from December 1999 through December 2014. A learning collaborative approach was used to implement AS-DT using an electronic medical record admission order set at hospital admission in phase 3 of the study. Data from 10 study sites participating in all 3 phases were compared before (phases 1 and 2) and after (phase 3) diagnostic test recommendations were inserted into electronic medical record order sets.
resultsThe percentage of subjects with an indeterminate diagnosis decreased significantly between phases 1-2 (48.0%) and phase 3 (to 30.8%) (P = .0003). The 21-day cumulative incidence rates for liver transplantation were significantly different among phase 1 (34.6%), phase 2 (31.9%), and phase 3 (20.2%) (P = .030). The 21-day cumulative incidence rates for death did not differ significantly among phase 1 (17.9%), phase 2 (11.9%), and phase 3 (11.3%) (P = .20).
conclusionsIn a multinational study of children with acute liver failure, we found that incorporating diagnostic test recommendations into electronic medical record order sets accessed at time of admission reduced the percentage with an indeterminate diagnosis that may have reduced liver transplants without increasing mortality. Widespread use of this approach could significantly enhance care of acute liver failure in children.
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