P44 Liver ultrasound practice is heterogenous and failing to highlight clinically significant liver disease

AbstractLiver ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient “abnormal LFT” US, and its efficacy in the risk stratification of liver disease.Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication “abnormal LFTs” 04–17/10/21.Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported – this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery – on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. Of the 281 scans reporting “fatty liver”, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 16% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the terminology “cirrhosis” was mentioned in only 5 of these scan reports (11%) and referral to Gastroenterology recommended in only 1 – implying at least 884 missed opportunities to diagnose cirrhosis in Scotland per year.Conclusions Current liver ultrasound practice is heterogenous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways

P80 Ultrasound practice is heterogeneous and failing to highlight clinically significant liver disease

Introduction Abdominal ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient “abnormal LFT” US, and its efficacy in the risk stratification of liver disease.Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication “abnormal LFTs” 04-17/10/21.Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported – this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery - on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. of the 281 scans reporting “fatty liver”, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 15% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the word “cirrhosis” was mentioned in only 5 of these scans (11%) and referral to Gastroenterology recommended in only 1 - meaning at least 884 missed opportunities to diagnose cirrhosis/year.The results suggest a crude incidence of fatty liver of 141/100,000/year and a crude incidence of cirrhosis of 22/100,000/year; however there was significant variability across Health Boards (range 0-381 and 0-62/100,000/year, respectively). The crude incidence did not relate to the reported crude prevalence of type 2 diabetes mellitus or alcohol related mortality rate, and instead increased with the number of scans performed/100,000 population.Conclusions US practice is heterogeneous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways

P80 Ultrasound practice is heterogeneous and failing to highlight clinically significant liver disease

Introduction Abdominal ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient “abnormal LFT” US, and its efficacy in the risk stratification of liver disease.Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication “abnormal LFTs” 04-17/10/21.Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported – this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery - on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. of the 281 scans reporting “fatty liver”, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 15% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the word “cirrhosis” was mentioned in only 5 of these scans (11%) and referral to Gastroenterology recommended in only 1 - meaning at least 884 missed opportunities to diagnose cirrhosis/year.The results suggest a crude incidence of fatty liver of 141/100,000/year and a crude incidence of cirrhosis of 22/100,000/year; however there was significant variability across Health Boards (range 0-381 and 0-62/100,000/year, respectively). The crude incidence did not relate to the reported crude prevalence of type 2 diabetes mellitus or alcohol related mortality rate, and instead increased with the number of scans performed/100,000 population.Conclusions US practice is heterogeneous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways

P44 Liver ultrasound practice is heterogenous and failing to highlight clinically significant liver disease

AbstractLiver ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient “abnormal LFT” US, and its efficacy in the risk stratification of liver disease.Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication “abnormal LFTs” 04–17/10/21.Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported – this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery – on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. Of the 281 scans reporting “fatty liver”, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 16% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the terminology “cirrhosis” was mentioned in only 5 of these scan reports (11%) and referral to Gastroenterology recommended in only 1 – implying at least 884 missed opportunities to diagnose cirrhosis in Scotland per year.Conclusions Current liver ultrasound practice is heterogenous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways

Association of cerebral venous thrombosis with recent COVID-19 vaccination : case-crossover study using ascertainment through neuroimaging in Scotland

BackgroundTo investigate the association of primary acute cerebral venous thrombosis (CVT) with COVID-19 vaccination through complete ascertainment of all diagnosed CVT in the population of Scotland.MethodsCase-crossover study comparing cases of CVT recently exposed to vaccination (1-14 days after vaccination) with cases less recently exposed. Cases in Scotland from 1 December 2020 were ascertained through neuroimaging studies up to 17 May 2021 and diagnostic coding of hospital discharges up to 28 April 2021, linked to national vaccination records. The main outcome measure was primary acute CVT.ResultsOf 50 primary acute CVT cases, 29 were ascertained only from neuroimaging studies, 2 were ascertained only from hospital discharges, and 19 were ascertained from both sources. Of these 50 cases, 14 had received the Astra-Zeneca ChAdOx1 vaccine and 3 the Pfizer BNT162b2 vaccine. The incidence of CVT per million doses in the first 14 days after vaccination was 2.2 (95% credible interval 0.9 to 4.1) for ChAdOx1 and 1 (95% credible interval 0.1 to 2.9) for BNT162b2. The rate ratio for CVT associated with exposure to ChAdOx1 in the first 14 days compared with exposure 15-84 days after vaccination was 3.2 (95% credible interval 1.1 to 9.5).ConclusionsThese findings support a causal association between CVT and the AstraZeneca vaccine. The absolute risk of post-vaccination CVT in this population-wide study in Scotland was lower than has been reported for populations in Scandinavia and Germany; the explanation for this is not clear