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

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 . 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

Mental Imagery to Reduce Alcohol-related harm in patients with alcohol use disorder and alcohol-related liver damaGE: the MIRAGE randomised pilot trial results

“…The sample of patients recruited to the trial is likely to be representative of the target population. The mean age of 49.3 years is comparable to data from English Hospital Episode Statistics in which mean age of ARLD patients ranged between 51 and 53 years over the last decade 3. The proportion of males (63%) is similar to previously reported national (66%) and regional datasets (63%) 3 38.…”

“…Globally, alcohol use is the leading cause of premature death or disability in adults younger than 50 years 1. In the UK, alcohol contributed to almost 1 million unplanned hospital admissions in 2020/2021, of which 39 667 were due to alcohol-related liver disease (ARLD) 2 3. Alcohol-specific deaths increased by 20% in 2020/2021, of which 80.3% were due to ARLD 4.…”

Editorial: the burden of alcohol‐related liver disease emergency admissions in England may be twice as high as previously thought—authorsʼ reply

“…Hence, we developed and validated a cohort discovery algorithm to reflect the diversity of real‐world coding patterns. As reported in our latest paper, 2 when applied to national data, this method doubles the apparent burden of ARLD compared with the current definition. The use of a simple tool to replicate the case‐finding method in local data sets proved feasible and could support local, regional and national QI efforts.…”

“…We thank King and colleagues for their insightful commentary on our recent paper 1,2 . In 2017, the UK Lancet Commission on Liver disease proposed a set of metrics to chart the burden and consequences of liver disease on an annual basis – including statistics on admissions and in‐hospital deaths for alcohol‐related liver disease (ARLD) derived from administrative data 3 .…”

Editorial: the burden of alcohol‐related liver disease emergency admissions in England may be twice as high as previously thought

“…In England, Hospital Episode Statistics (HES) contain records of all patients admitted to National Health Service hospitals, and provide crucial data for research and healthcare performance assessment 4 . As Dhanda and colleagues 5 explain, a ‘standard approach’ exists for identifying emergency admissions with ALD, using International Classification of Diseases (ICD‐10) codes. In this approach, used by Public Health England, patients are classified as having ALD if their ‘primary diagnosis’ is coded under the ICD‐10 category ‘alcoholic liver disease’.…”