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<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK548543" /><meta name="ncbi_domain" content="livertox" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK548543/" /><meta name="ncbi_pagename" content="Causality Assessment Tools - LiverTox - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Causality Assessment Tools" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2019/05/04" /><meta name="citation_pmid" content="31689033" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548543/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Causality Assessment Tools" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2019/05/04" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548543/" /><meta name="description" content="Drug induced liver injury is a diagnosis of exclusion that rests upon ruling out other common causes of liver disease, and knowledge of the pattern of injury associated with the specific drug. Unlike in hepatitis A or B, for instance, there are no specific diagnostic tests that establish causality for drug induced liver injury. The diagnosis can also be very challenging and even experts can disagree on the likelihood of the causality. For these reasons, attempts have been made to standardize causality assessment in drug induced adverse events including hepatotoxicity. These "instruments" generally rely upon careful delineation of the timing of onset of the adverse event in relation to starting the medication (challenge), and the timing of resolution in relation to stopping the medication (dechallenge). The causality is greatly strengthened if there is a recurrence on reexposure (rechallenge). Other helpful features are signs and symptoms of hypersensitivity, know drug allergies, the absence of competing diagnoses, and previous information on the occurrence of a similar adverse event with the medication. These factors are variously captured in the causality instruments and given various weights to achieve a rating score for the likelihood of the medication causing the injury. Commonly used instruments include the Naranjo Probability Scale, which is not specific to liver injury and can be used for any type of adverse drug reaction. In contrast, the Roussel Uclaf Causality Assessment Method (RUCAM) and its modification known as the Maria and Victorino (M & V) System, were developed specifically for drug induced liver injury. All three causality instruments have been used widely and perform reasonably well in comparison to the "gold standard" of expert opinion. These three causality assessment tools are discussed in detail in the links below, and the actual forms are provided in pdf files that can be printed. In addition, guidance is provided on how to fill out the forms. A computerized version of the RUCAM scale is used in the section of LiverTox called "Submit a Case Report." However, subjective features of all of the causality assessment instruments make computerized computations difficult and not as reliable as individual assignment of scores on the forms." /><meta name="og:title" content="Causality Assessment Tools" /><meta name="og:type" content="book" /><meta name="og:description" content="Drug induced liver injury is a diagnosis of exclusion that rests upon ruling out other common causes of liver disease, and knowledge of the pattern of injury associated with the specific drug. Unlike in hepatitis A or B, for instance, there are no specific diagnostic tests that establish causality for drug induced liver injury. The diagnosis can also be very challenging and even experts can disagree on the likelihood of the causality. For these reasons, attempts have been made to standardize causality assessment in drug induced adverse events including hepatotoxicity. These "instruments" generally rely upon careful delineation of the timing of onset of the adverse event in relation to starting the medication (challenge), and the timing of resolution in relation to stopping the medication (dechallenge). The causality is greatly strengthened if there is a recurrence on reexposure (rechallenge). Other helpful features are signs and symptoms of hypersensitivity, know drug allergies, the absence of competing diagnoses, and previous information on the occurrence of a similar adverse event with the medication. These factors are variously captured in the causality instruments and given various weights to achieve a rating score for the likelihood of the medication causing the injury. Commonly used instruments include the Naranjo Probability Scale, which is not specific to liver injury and can be used for any type of adverse drug reaction. In contrast, the Roussel Uclaf Causality Assessment Method (RUCAM) and its modification known as the Maria and Victorino (M & V) System, were developed specifically for drug induced liver injury. All three causality instruments have been used widely and perform reasonably well in comparison to the "gold standard" of expert opinion. These three causality assessment tools are discussed in detail in the links below, and the actual forms are provided in pdf files that can be printed. In addition, guidance is provided on how to fill out the forms. A computerized version of the RUCAM scale is used in the section of LiverTox called "Submit a Case Report." However, subjective features of all of the causality assessment instruments make computerized computations difficult and not as reliable as individual assignment of scores on the forms." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548543/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/causalityassess/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548543/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548543_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548543_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Causality/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/MVcausality/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548543_"><span class="title" itemprop="name">Causality Assessment Tools</span></h1><p class="small">Last Update: <span itemprop="dateModified">May 4, 2019</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><p>Drug induced liver injury is a diagnosis of exclusion that rests upon ruling out other common causes of liver disease, and knowledge of the pattern of injury associated with the specific drug. Unlike in hepatitis A or B, for instance, there are no specific diagnostic tests that establish causality for drug induced liver injury. The diagnosis can also be very challenging and even experts can disagree on the likelihood of the causality. For these reasons, attempts have been made to standardize causality assessment in drug induced adverse events including hepatotoxicity. These "instruments" generally rely upon careful delineation of the timing of onset of the adverse event in relation to starting the medication (challenge), and the timing of resolution in relation to stopping the medication (dechallenge). The causality is greatly strengthened if there is a recurrence on reexposure (rechallenge). Other helpful features are signs and symptoms of hypersensitivity, know drug allergies, the absence of competing diagnoses, and previous information on the occurrence of a similar adverse event with the medication. These factors are variously captured in the causality instruments and given various weights to achieve a rating score for the likelihood of the medication causing the injury. Commonly used instruments include the Naranjo Probability Scale, which is not specific to liver injury and can be used for any type of adverse drug reaction. In contrast, the Roussel Uclaf Causality Assessment Method (<a class="def" href="/books/n/livertox/glossary/def-item/glossary.rucam/">RUCAM</a>) and its modification known as the Maria and Victorino (M & V) System, were developed specifically for drug induced liver injury. All three causality instruments have been used widely and perform reasonably well in comparison to the "gold standard" of expert opinion. These three causality assessment tools are discussed in detail in the links below, and the actual forms are provided in pdf files that can be printed. In addition, guidance is provided on how to fill out the forms. A computerized version of the RUCAM scale is used in the section of LiverTox called "Submit a Case Report." However, subjective features of all of the causality assessment instruments make computerized computations difficult and not as reliable as individual assignment of scores on the forms.</p><ul><li class="half_rhythm"><div>
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<a href="/books/n/livertox/MVcausality/">Maria & Victorino (M & V) System of Causality Assessment</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/livertox/Narajo/">Adverse Drug Reaction Probability Scale (Naranjo)</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/livertox/rucam/">Roussel Uclaf Causality Assessment System (RUCAM)</a>
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</div></li></ul><div id="bk_toc_contnr"></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK548543</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/31689033" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">31689033</a></span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Causality/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/MVcausality/" title="Next page in this title">Next ></a></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548543/?report=reader">PubReader</a></li><li><a href="/books/NBK548543/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548543" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548543" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Causality Assessment Tools. [Updated 2019 May 4].<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/NBK548543/pdf/Bookshelf_NBK548543.pdf">PDF version of this page</a> (52K)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>New and Updated</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22LiverTox%22+AND+pmcbook&sort=date&size=200" ref="pagearea=source-links&targetsite=external&targetcat=link&targettype=uri">In PubMed</a></li></ul></div></div><div class="portlet"><div 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