Emergency center laboratory evaluation of pediatric trauma victims.
Emergency center (ER) trauma evaluations often include leukocyte count (LC), serum amylase (SA), electrolytes (EL), and urine analysis. We reviewed records of 100 pediatric ER patients to determine utility of these tests in management of blunt injury. SA was evaluated in 65 patients and ranged from 30-146 U/L (mean 50.6 U/L); 14 patients with normal CT scans had SA from 30-68 U/L (mean 49.1 U/L). Six patients with intraabdominal or retroperitoneal injuries had SA from 30-130 U/L (mean 64.0 U/L), P = NS. LC was determined in 76 patients and ranged 2.3-28.3 k/ml (mean 13.8 k/ml). Patients with normal abdominal CT (12) had mean LC 14.8 k/ml (range 7.2-19.6 k/ml). Eight patients with injuries on CT had mean LC 14.4 k/ml (range 3.5-27.1 k/ml). ER, SA, and LC did not alter patient management. Thirty-four patients had serum sodium, 36 potassium, and 33 chloride and bicarbonate determinations. Sodium, potassium, and chloride levels were uniformly normal; bicarbonate and leukocyte counts were uniformly abnormal in initial evaluations. These changes are expected in response to severe injury and their determinations did not alter patient care. Combined laboratory urinarlysis (LA) and urine dipstick (DA) analysis for hematuria had sensitivity 75.0 per cent (specificity 81.6%). LA predicted injury with sensitivity 75.0 per cent (specificity 81.6%). DA predicted injury with sensitivity 60.0 per cent (specificity 79.2%). DA accurately represented LA results (sensitivity 100%, specificity of 94.5%). DA is a rapid and effective replacement of LA in evaluation of trauma patients in the emergency center.
Division of Pediatric Surgery, Childrens Hospital of Los Angeles, CA 90027.
E G
EG
Ford
H L
HL
Karamanoukian
N
N
McGrath
G H
GH
Mahour
D000681:Amylases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D004573:Electrolytes / Q000032:analysis; D004636:Emergency Service, Hospital / Q000592:standards*; D005069:Evaluation Studies as Topic; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014556:Urine / Q000737:chemistry; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000453:epidemiology / Q000652:urine
D004573:Electrolytes; D000681:Amylases