Management of Acetaminophen Hepatotoxicity: A Survey of Practicing Physicians

• Objective: To assess and compare practicing gastroenterologist and primary care physician (PCP) knowledge of risk factors for, clinical management of, and attitudes toward liver transplantation for acetaminophen hepatotoxicity. • Participants and setting: 333 PCPs and 64 gastroenterologists practicing in Michigan. • Outcome measures: Knowledge of risk factors and management were measured by survey items and a summative knowledge index and a summative management index; attitude toward liver transplantation was measured by survey items. • Results: Gastroenterologists were more likely than PCPs to have treated at least 1 patient with acetaminophen hepatotoxicity in the past year (P ≤ 0.001). Knowledge of acetaminophen hepatotoxicity risk fa ctors was high in both groups. However, prolonged fasting was correctly identified as a risk factor by only 57% of all respondents. Gastroenterologists were significantly more likely to recommend N-acetylcysteine (NAC) in cases of nonintentional acetaminophen hepatotoxicity, refer patients with severe acetaminophen hepatotoxicity for liver transplant evaluation, and have higher management index scores compared with PCP respondents (P ≤ 0.001). Gastroenterologists were also more likely to endorse liver transplantation for patients with intentional acetaminophen hepatotoxicity compared with PCPs (74% versus 59%, P ≤ 0.001). • Conclusions: Knowledge of risk factors for acetaminophen hepatotoxicity was high in both physician groups. As expected, gastroenterologists were more familiar with the clinical management of acetaminophen hepatotoxicity. In addition to further education of practicing physicians, assessment of consumer behavior and knowledge may be warranted to address the rising incidence of nonintentional acetaminophen hepatotoxicity in the United States.