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The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy.
Hepatology. 2013 Sep; 58(3):1122-32.Hep

Abstract

Minimal hepatic encephalopathy (MHE) detection is difficult because of the unavailability of short screening tools. Therefore, MHE patients can remain undiagnosed and untreated. The aim of this study was to use a Stroop smartphone application (app) (EncephalApp_Stroop) to screen for MHE. The app and standard psychometric tests (SPTs; 2 of 4 abnormal is MHE, gold standard), psychometric hepatic encephalopathy score (PHES), and inhibitory control tests (ICTs) were administered to patients with cirrhosis (with or without previous overt hepatic encephalopathy; OHE) and age-matched controls from two centers; a subset underwent retesting. A separate validation cohort was also recruited. Stroop has an "off" state with neutral stimuli and an "on" state with incongruent stimuli. Outcomes included time to complete five correct runs as well as number of trials needed in on (Ontime) and off (Offtime) states. Stroop results were compared between controls and patients with cirrhosis with or without OHE and those with or without MHE (using SPTs, ICTs, and PHES). Receiver operating characteristic analysis was performed to diagnose MHE in patients with cirrhosis with or without previous OHE. One hundred and twenty-five patients with cirrhosis (43 previous OHE) and 134 controls were included in the original cohort. App times were correlated with Model for End-Stage Liver Disease (Offtime: r = 0.57; Ontime: r = 0.61; P < 0.0001) and were worst in previous OHE patients, compared to the rest and controls. Stroop performance was also significantly impaired in those with MHE, compared to those without MHE, according to SPTs, ICTs, and PHES (all P < 0.0001). A cutoff of >274.9 seconds (Ontime plus Offtime) had an area under the curve of 0.89 in all patients and 0.84 in patients without previous OHE for MHE diagnosis using SPT as the gold standard. The validation cohort showed 78% sensitivity and 90% specificity with the >274.9-seconds Ontime plus Offtime cutoff. App result patterns were similar between the centers. Test-retest reliability in controls and those without previous OHE was good; a learning effect on Ontime in patients with cirrhosis without previous OHE was noted.

CONCLUSION

The Stroop smartphone app is a short, valid, and reliable tool for screening of MHE.

Authors+Show Affiliations

Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23389962

Citation

Bajaj, Jasmohan S., et al. "The Stroop Smartphone Application Is a Short and Valid Method to Screen for Minimal Hepatic Encephalopathy." Hepatology (Baltimore, Md.), vol. 58, no. 3, 2013, pp. 1122-32.
Bajaj JS, Thacker LR, Heuman DM, et al. The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology. 2013;58(3):1122-32.
Bajaj, J. S., Thacker, L. R., Heuman, D. M., Fuchs, M., Sterling, R. K., Sanyal, A. J., Puri, P., Siddiqui, M. S., Stravitz, R. T., Bouneva, I., Luketic, V., Noble, N., White, M. B., Monteith, P., Unser, A., & Wade, J. B. (2013). The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology (Baltimore, Md.), 58(3), 1122-32. https://doi.org/10.1002/hep.26309
Bajaj JS, et al. The Stroop Smartphone Application Is a Short and Valid Method to Screen for Minimal Hepatic Encephalopathy. Hepatology. 2013;58(3):1122-32. PubMed PMID: 23389962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. AU - Bajaj,Jasmohan S, AU - Thacker,Leroy R, AU - Heuman,Douglas M, AU - Fuchs,Michael, AU - Sterling,Richard K, AU - Sanyal,Arun J, AU - Puri,Puneet, AU - Siddiqui,Mohammad S, AU - Stravitz,Richard T, AU - Bouneva,Iliana, AU - Luketic,Velimir, AU - Noble,Nicole, AU - White,Melanie B, AU - Monteith,Pamela, AU - Unser,Ariel, AU - Wade,James B, Y1 - 2013/05/23/ PY - 2012/11/19/received PY - 2013/01/08/revised PY - 2013/01/31/accepted PY - 2013/2/8/entrez PY - 2013/2/8/pubmed PY - 2014/2/14/medline SP - 1122 EP - 32 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 58 IS - 3 N2 - UNLABELLED: Minimal hepatic encephalopathy (MHE) detection is difficult because of the unavailability of short screening tools. Therefore, MHE patients can remain undiagnosed and untreated. The aim of this study was to use a Stroop smartphone application (app) (EncephalApp_Stroop) to screen for MHE. The app and standard psychometric tests (SPTs; 2 of 4 abnormal is MHE, gold standard), psychometric hepatic encephalopathy score (PHES), and inhibitory control tests (ICTs) were administered to patients with cirrhosis (with or without previous overt hepatic encephalopathy; OHE) and age-matched controls from two centers; a subset underwent retesting. A separate validation cohort was also recruited. Stroop has an "off" state with neutral stimuli and an "on" state with incongruent stimuli. Outcomes included time to complete five correct runs as well as number of trials needed in on (Ontime) and off (Offtime) states. Stroop results were compared between controls and patients with cirrhosis with or without OHE and those with or without MHE (using SPTs, ICTs, and PHES). Receiver operating characteristic analysis was performed to diagnose MHE in patients with cirrhosis with or without previous OHE. One hundred and twenty-five patients with cirrhosis (43 previous OHE) and 134 controls were included in the original cohort. App times were correlated with Model for End-Stage Liver Disease (Offtime: r = 0.57; Ontime: r = 0.61; P < 0.0001) and were worst in previous OHE patients, compared to the rest and controls. Stroop performance was also significantly impaired in those with MHE, compared to those without MHE, according to SPTs, ICTs, and PHES (all P < 0.0001). A cutoff of >274.9 seconds (Ontime plus Offtime) had an area under the curve of 0.89 in all patients and 0.84 in patients without previous OHE for MHE diagnosis using SPT as the gold standard. The validation cohort showed 78% sensitivity and 90% specificity with the >274.9-seconds Ontime plus Offtime cutoff. App result patterns were similar between the centers. Test-retest reliability in controls and those without previous OHE was good; a learning effect on Ontime in patients with cirrhosis without previous OHE was noted. CONCLUSION: The Stroop smartphone app is a short, valid, and reliable tool for screening of MHE. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/23389962/The_Stroop_smartphone_application_is_a_short_and_valid_method_to_screen_for_minimal_hepatic_encephalopathy_ L2 - https://doi.org/10.1002/hep.26309 DB - PRIME DP - Unbound Medicine ER -