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Peer-reviewedCC BYThe western journal of emergency medicine

Emergency Department Evaluation and Care of Hepatic Encephalopathy: ACEP Expert Panel Recommendations.

  • Christopher W Baugh1
  • Arun B Jesudian2
  • Stanley C Thompson3
  • Christi Jen4
  • William Ford5
  • James F Neuenschwander6
  • Edgardo Ordonez7
  • Alpesh N Amin8
8 affiliations
  1. 1Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts.
  2. 2Weill Cornell Medicine, Division of Gastroenterology and Hepatology, New York, New York.
  3. 3TeamHealth Lifepoint Group, Nashville, Tennessee.
  4. 4Mayo Clinic, Department of Pharmacy, Phoenix, Arizona.
  5. 5Jefferson Health, Division of Hospital Medicine, Abington, Pennsylvania.
  6. 6Ohio State University, Department of Emergency Medicine, Columbus, Ohio.
  7. 7Baylor College of Medicine, Henry J. N. Taub Department of Emergency Medicine, Houston, Texas.
  8. 8University of California, Irvine, Department of Medicine, Irvine, California.
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Abstract

Introduction

Patients with hepatic encephalopathy frequently visit the emergency department, and these visits are expected to rise in the coming years due to an increased prevalence of liver disease in the United States. Accordingly, we sought to define a comprehensive and efficient approach for emergency physicians to evaluate, treat, and determine the optimal disposition of patients presenting with possible or confirmed hepatic encephalopathy and its complications.Methods

We reached consensus recommendations through a structured literature review and a modified Delphi technique, informing an expert panel of academic and community emergency physicians convened by the American College of Emergency Physicians.Results

We created the assess, look, treat, evaluate risk, reassess, disposition (ALTERD) framework as a digital point-of-care tool to support clinicians in guiding key bedside steps involved in the diagnosis and care of patients across the spectrum of hepatic encephalopathy.Conclusion

A collaborative expert panel process can create an emergency department-focused, easily accessible, and comprehensive digital tool to complement workflows and improve the care of a vulnerable and growing patient population.

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Cite

BibTeXRIS
BibTeX
@article{baugh2026emergency,
  title = {{Emergency Department Evaluation and Care of Hepatic Encephalopathy: ACEP Expert Panel Recommendations.}},
  author = {Christopher W Baugh and Arun B Jesudian and Stanley C Thompson and Christi Jen and William Ford and James F Neuenschwander and Edgardo Ordonez and Alpesh N Amin},
  journal = {The western journal of emergency medicine},
  year = {2026},
  month = aug,
  doi = {10.5811/westjem.63064},
  url = {https://europepmc.org/article/MED/42900941},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Emergency Department Evaluation and Care of Hepatic Encephalopathy: ACEP Expert Panel Recommendations.
AU  - Christopher W Baugh
AU  - Arun B Jesudian
AU  - Stanley C Thompson
AU  - Christi Jen
AU  - William Ford
AU  - James F Neuenschwander
AU  - Edgardo Ordonez
AU  - Alpesh N Amin
PY  - 2026
DA  - 2026/08/17
JO  - The western journal of emergency medicine
DO  - 10.5811/westjem.63064
UR  - https://europepmc.org/article/MED/42900941
AB  - Introduction  Patients with hepatic encephalopathy frequently visit the emergency department, and these visits are expected to rise in the coming years due to an increased prevalence of liver disease in the United States. Accordingly, we sought to define a comprehensive and efficient approach for emergency physicians to evaluate, treat, and determine the optimal disposition of patients presenting with possible or confirmed hepatic encephalopathy and its complications.Methods  We reached consensus recommendations through a structured literature review and a modified Delphi technique, informing an expert panel of academic and community emergency physicians convened by the American College of Emergency Physicians.Results  We created the assess, look, treat, evaluate risk, reassess, disposition (ALTERD) framework as a digital point-of-care tool to support clinicians in guiding key bedside steps involved in the diagnosis and care of patients across the spectrum of hepatic encephalopathy.Conclusion  A collaborative expert panel process can create an emergency department-focused, easily accessible, and comprehensive digital tool to complement workflows and improve the care of a vulnerable and growing patient population.
SN  - 1936-900X
SN  - 1936-9018
ER  -