Table 3.

Clinical Comparison between Management of Standardized Patients with HE < Grade 2 vs HE Grade ≥2.

	<Grade 2 %	Appropriateness	≥2 Grade %	Appropriateness	p value
History
Stool Frequency	82	Yes	91	Yes	0.002
Medication History	88	Yes	97	Yes	<0.001
Physical Examination
Neurological examination for focal deficits	23	Yes	82	Yes	<0.001
Neurological examination for herniation	0	No	32	Yes	<0.001
Investigations					<0.001
MHE Testing	70	Yes	20	No	<0.001
Brain Scan	4	No	47	Varies	<0.001
Comprehensive metabolic panel	62	Yes	98	Yes	<0.001
Complete blood count	55	Varies	99	Yes	<0.001
Blood cultures	3	Varies	89	Yes	<0.001
Urinalysis	11	Varies	92	Yes	<0.001
Blood ammonia	11	No	36	No	<0.001
Urine drug screen	27	Varies	80	Varies	<0.001
Blood alcohol level	24	Varies	74	Varies	<0.001
INR	38	Yes	89	Yes	<0.001
Hemoccult	5	No	20	No	<0.001
Management(non-specific)					<0.001
Hospital Admission	2	No	94	Yes	<0.001
ICU Admission	0	No	33	Varies	<0.001
Nasogastric intubation	0	No	24	Varies	<0.001
Endotracheal intubation	0	No	19	Varies	<0.001
Specific treatments
Lactulose	58	Case by case basis	93	Yes	<0.001
Rifaximin	14	No	50	Varies	<0.001
Antibiotics	0	No	19	Varies	<0.001
IV Albumin	0	No	11	No	<0.001
Nutritional management					<0.001
Nutritional consultation	42	Yes	65	Yes	<0.001
Low Protein diet	9	No	12	No	0.19

P values were calculated using Chi-Square or Fisher Exact Test as necessary. Appropriateness was based on the EASL/AASLD 2014 HE guidelines. MHE: minimal hepatic encephalopathy, ICU: intensive care unit