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A Reliable Screening Test to Predict Liver Injury in Pediatric Blunt Torso Trauma

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Abstract

Objectives:

We determined the validity of serumaspartate aminotransferase (AST) and alanine aminotransferase(ALT) as screening tests in the identificationof liver injuries in pediatric torso trauma patients.

Methods:

We conducted a retrospective study inpediatric patients < 17 years of age who sustainedblunt trauma and were admitted to an urban traumacenter during a 39-month period. The serum AST andALT levels, injury severity scores (ISS), lengths of hospitaland intensive care unit stays, laparotomy andvascular embolization requirement, mortality rate, andconcomitant injuries were compared betweenpatients with and without liver injury.

Results:

Of the 40 patients reviewed, 16 patients hadliver injuries. The mean serum AST and ALT levels weremarkedly higher in the liver injury (LI) group than inthe non-liver injury (NLI) group (773.4 IU/l ± 781.3 [SD]and 613.6 IU/l ± 640.0 [SD], respectively, and (67.2IU/l ± 63.2 [SD] and 55.5 IU/l ± 62.6 [SD], respectively;p < 0.01). One of the 16 LI patients and 20 of the 24 NLIpatients had AST levels < 200 IU/l or ALT levels < 125IU/l. The sensitivity, specificity, and positive and negativepredictive values were 94, 83, 79, and 95%,respectively.

Conclusions:

A serum AST > 200 IU/l or an ALT> 125 IU/l are strong predictors of liver injury in childrensustaining blunt torso trauma. We recommend theroutine use of serum transaminase levels as screeningtests in hemodynamically stable patients.

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References

  1. Coant PN, Kornberg AE, Brody AS, Edwards-Holmes K. Markers for occult liver injury in cases of physical abuse in children. Pediatrics 1992;89:274–8.

    CAS  PubMed  Google Scholar 

  2. Hennes HM, Smith DS, Schneider K, Hegenbarth MA, Duma MA, Jona JZ. Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics 1990;86:87–90.

    CAS  PubMed  Google Scholar 

  3. Puranik SR, Hayes JS, Long J, Mata M. Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children. South Med J 2002;95:203–9.

    PubMed  Google Scholar 

  4. Karaduman D, Sarioglu-Buke A, Kilic I, Gurses E. The role of elevated liver transaminase levels in children with blunt abdominal trauma. Injury 2003;34:249–52.

    Article  PubMed  Google Scholar 

  5. Holmes JF, Sokolove PE, Brant WE, Palchak MJ, Vance CW, Owings JT, Kuppermann N. Identification of children with intraabdominal injuries after blunt trauma. Ann Emerg Med 2002;39:500–9.

    Article  PubMed  Google Scholar 

  6. Keller MS, Coln CE, Trimble JA, Green MC, Weber TR. The utility of routine trauma laboratories in pediatric trauma resuscitations. Am J Surg 2004;188:671–8.

    Article  PubMed  Google Scholar 

  7. Stassen NA, Lukan JK, Carrillo EH, Spain DA, Norfleet LA, Miller FB, Polk HC Jr. Examination of the role of abdominal computed tomography in the evaluation of victims of trauma with increased aspartate aminotransferase in the era of focused abdominal sonography for trauma. Surgery 2002;132:642–6.

    Article  PubMed  Google Scholar 

  8. Shanmuganathan K, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology 1999;212:423–30.

    CAS  PubMed  Google Scholar 

  9. Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, Hahn J, Mermillod B. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma 2004;57:1072–81.

    Article  PubMed  Google Scholar 

  10. Faidi S, Mahassni S, Gagarine A, Sagar M, Baillie F. Seat belt mark sign: a predictor of bowel injury in trauma patients. J Trauma 2004;57:459.

    Google Scholar 

  11. Holmes JF, Sokolove PE, Land C, Kuppermann N. Identification of intra-abdominal injuries in children hospitalized following blunt torso trauma. Acad Emerg Med 1999;6:799–806.

    Article  CAS  PubMed  Google Scholar 

  12. Isaacman DJ, Scarfone RJ, Kost SI, Gochman RF, Davis HW, Bernardo LM, Nakayama DK. Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient. Pediatrics 1993;92:691–4.

    CAS  PubMed  Google Scholar 

  13. Capraro AJ, Mooney D, Waltzman ML. The use of routine laboratory studies as screening tools in pediatric abdominal trauma. Pediatr Emerg Care 2006;22:480–4.

    Article  PubMed  Google Scholar 

  14. Miller K, Kou D, Sivit C, Stallion A, Dudgeon DL, Grisoni ER. Pediatric hepatic trauma: does clinical course support intensive care unit stay? J Pediatr Surg 1998;33:1459–62.

    Article  CAS  PubMed  Google Scholar 

  15. David Richardson J, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, Wilson MA, Polk HC Jr, Flint LM. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 2000;232:324–30.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan

    Feng-Yuan Chu, Hung-Jung Lin, Tsan-Hsing Liu & Kuo-Tai Chen MD

  2. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan

    Hung-Jung Lin & Kuo-Tai Chen MD

  3. Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan

    Hung-Jung Lin

  4. Department of Environmental and Occupational Health and Department of Environmental and Occupational Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan

    How-Ran Guo & Ning-Ping Foo

  5. Department of Emergency Medicine, Chi-Mei Medical Center, Liouying, Taiwan

    Ning-Ping Foo

  6. Emergency Department, Chi-Mei Medical Center, 901 Chung-Hwa Road Yung Kang, Tainan, 710, Taiwan

    Kuo-Tai Chen MD

Authors
  1. Feng-Yuan Chu
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  2. Hung-Jung Lin
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  3. How-Ran Guo
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  4. Tsan-Hsing Liu
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  6. Kuo-Tai Chen MD
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Corresponding author

Correspondence to Kuo-Tai Chen MD.

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Chu, FY., Lin, HJ., Guo, HR. et al. A Reliable Screening Test to Predict Liver Injury in Pediatric Blunt Torso Trauma. Eur J Trauma 36, 44–48 (2010). https://doi.org/10.1007/s00068-009-9034-z

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  • DOI: https://doi.org/10.1007/s00068-009-9034-z

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