Sufferers were excluded if indeed they were getting investigated seeing that an outpatient or aged under 18. Data collection The digital records system were used to acquire demographic data, as well as the results of the next tests for each patient: ultrasound liver organ, serology for Hepatitis A, B, C, D, E, HIV, EBV and CMV, liver auto-antibodies, caeruloplasmin, alpha-1-anti-trypsin, ferritin, ANA, immunoglobulins, LFTs and full blood count. low yield of unselected testing in patients with abnormal liver function tests. A thorough history, ultrasound and testing for blood-borne viruses are the cornerstones of diagnosis. Specialist input should be sought before further testing. Prospective studies to evaluate the yield and cost-effectiveness of different testing strategies are needed. strong class=”kwd-title” Keywords: Clinical diagnostic tests Introduction Liver disease is increasing and now accounts for 1.5% of deaths in the United Kingdom.1 As a result, the assessment of patients with DM1-Sme both incidental and persistently abnormal liver function tests (LFTs) is an increasingly common clinical problem encountered by the acute physician. The use of a liver-screen to test not only for viral causes of liver disease but also for metabolic and inherited conditions is common clinical practice,2C4 although there are limited data to support such an approach in the inpatient settings. Studies in the community suggest that the yield of unselected testing is low. In studies of patients with incidental derangement of their LFTs, the yield of a liver screen was between 3 and 10%.5,6 In contrast, a cause can be identified in over 75% of patients with persistently elevated LFTs.7C9 This suggests that biochemical liver screens can be safely delayed until a persistent elevation of LFTs is demonstrated. The only study of acutely jaundiced patients showed imaging and clinical course to be the two most important factors in making a diagnosis.10 While individual elements of a liver screen are relatively low cost, unselected testing may result in substantial costs at a national level, 11 both from direct costs associated to testing and secondly in indirect costs due to prolonged inpatient stay, without a significant improvement in diagnostic yield. The aim of this audit was to evaluate the diagnostic yield of investigations ordered as part of routine clinical care for inpatients investigated for abnormal LFTs at a large acute hospital. Methods Audit population The hospital pathology records of every patient seen between 1 January 2011 and 31 December 2011 were reviewed. Requests for -1-antitrypsin, caeruloplasmin and liver auto-antibiodies were used to identify patients undergoing an unselected liver screen. Patients were excluded if they were being investigated as an outpatient or aged under 18. Data collection The electronic records system were used to obtain demographic data, and the results of the following tests for every patient: ultrasound liver, serology for Hepatitis A, B, C, D, E, HIV, CMV and EBV, liver auto-antibodies, caeruloplasmin, alpha-1-anti-trypsin, ferritin, ANA, immunoglobulins, LFTs and full blood count. Ultrasound reports were reviewed, and patients were categorised as having evidence of steatohepatitis, cirrhosis, biliary dilatation, gallstones, gallbladder wall thickening, ascites, portal hypertension and mass lesions. The cost of investigations was provided by the hospital laboratory department. This was used to calculate the cost per positive diagnosis of each investigation. Diagnoses Electronic records, clinic letters and discharge letters were DM1-Sme used to ascertain the clinical diagnosis for each patient, and where a clinical diagnosis was not given the clinical details and test results were reviewed by one author (MM) who assigned the patients to a diagnostic category. Ethical approval This was a DM1-Sme retrospective case note review of routine clinical data meeting the NHS definition of an audit12 and formal institutional review board approval was therefore not required. Results A total of 308 had an inpatient request for at least one of liver auto-antibodies, caeruloplasmim, -1-antitrypsin in 2011. The majority were male (n?=?200, 65%) with a median age of 51.5 years (IQR 41C68). Median peak ALT, ALP and Bilirubin was 76?IU/L (IQR 33C294?IU/L, normal range DM1-Sme 3C35?IU/L), 171?IU/L (IQR 89C299?IU/L, normal range 30 to 120?IU/L) and 23?mmol/L (IQR 9C70?mmol/L, normal range 3C17?mmol/L), respectively. On review of clinical records, no patient had a family history of Wilsons disease or -1-antitrypsin deficiency. Testing The frequency with which elements of the Liver Screen were sent is HDAC4 shown in Table 1. No investigation was organised in greater than 90% of patients. Testing for all three common hepatitis viruses (A,B,C) was carried out in 157 patients (51%). The combination of an ultrasound and testing for viral hepatitis was carried out in 110 patients (36%). Despite national guidelines,13 an HIV test was only sent in 36% of patients.