To scan or not to scan: Use of transient elastography in an integrated health system

Table 1 Patient demographics

Characteristic	Pre-clinical decision support tool (n = 115)	Post-clinical decision support tool (n = 843)	P value
Age, year	58.3 ± 13.78	57.1 ± 14.02	0.3777
Female (%)	53.9	53.3	0.8956
Body mass index	31.6 ± 6.13	33.1 ± 7.10	0.0358
Race (%)			0.4486
African American	4.3	3.3
Asian	19.1	17.4
Hispanic	47.8	56.8
Non-Hispanic White	25.2	19.9
Other, unknown	3.5	2.5
Insurance plan type (%)			0.1312
Commercial, private pay	64.3	64.7
Dual	3.5	5.9
Medicaid	6.1	4.5
Medicare	24.3	24.7
Other, unknown	1.7	0.2
Medical Comorbidities (%)
Chronic hepatitis B	2.6	1.8	0.5415
Chronic hepatitis C	4.3	1.3	0.0172
Diabetes mellitus	45.2	42.4	0.5572
Hepatocellular carcinoma	0	0
Hyperlipidemia	52.2	58.6	0.1891
Liver transplant	0	0.4	0.5212
Obstructive sleep apnea	14.7	13.3	0.6662
Polycystic ovarian syndrome	1.7	0.5	0.1076
Primary biliary cholangitis	0.9	0.4	0.4242
Primary sclerosing cholangitis	0	0

Data are expressed as mean ± SD or n (%).

Table 2 FibroScan data

Parameter	Pre-clinical decision support tool (n = 115)	Post-clinical decision support tool (n = 843)	P value
Physician ordering FibroScan (%)			< 0.0001
Primary care	33	67.1
Specialty care	67	32.9
Exam probe used (%)			0.9453
Medium	44.3	44
Extra large (XL)	55.7	56
FibroScan result (%)
Fibrosis score			0.0142
F0	32.2	38.1
F1	7.8	14.2
F2	17.4	17.9
F3	13.9	13.3
F4	28.7	16.5
Steatosis score			< 0.0001
S0	43.5	8.1
S1	4.3	10
S2	8.7	14.7
S3	43.5	67.3

Data are expressed as n (%).

Table 3 Patient morbidity and mortality

Variable	Pre-clinical decision support tool	Post-clinical decision support tool
Patients hospitalized in first year for:
Hepatic encephalopathy	0	1
Variceal bleeding	0	0
Spontaneous bacterial peritonitis	0	0
Liver cancer	0	2
Patients hospitalized at anytime for:
Hepatic encephalopathy	4	4
Variceal bleeding	1	0
Spontaneous bacterial peritonitis	1	0
Liver cancer	0	5
Patients deceased in first year	1	7
Patients deceased at any time	9	17

Data are expressed as raw numbers.

Table 4 Multivariable analysis

Variable	Fibrosis score	Odds ratio	95% confidence interval	P value
Lab tests	F1 vs F0	0.955	0.621-1.469	0.8354
	F2 vs F0	1.055	0.711-1.566	0.7886
	F3 vs F0	1.507	0.946-2.4	0.0845
	F4 vs F0	2.477	1.522-3.953	0.0001
Imaging study	F1 vs F0	0.825	0.506-1.343	0.4386
	F2 vs F0	1.287	0.855-1.937	0.2259
	F3 vs F0	4.703	3.064-7.218	< 0.0001
	F4 vs F0	7.188	4.793-10.78	< 0.0001
Gastroenterology referral	F1 vs F0	2.362	0.909-6.141	0.0778
	F2 vs F0	1.47	0.549-3.939	0.4431
	F3 vs F0	6.195	2.786-13.775	< 0.0001
	F4 vs F0	4.122	1.85-9.14	0.0005
Hepatology referral	F1 vs F2	0.181	0.04-0.813	0.0258
	F3 vs F2	4.438	2.253-8.739	< 0.0001
	F4 vs F2	4.55	2.385-8.681	< 0.0001
Health education referral	F1 vs F0	1.415	0.882-2.272	0.1501
	F2 vs F0	1.463	0.957-2.236	0.0786
	F3 vs F0	2.054	1.305-3.233	0.0019
	F4 vs F0	3.589	2.391-5.387	< 0.0001