Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury.
The medical records of 43 hemodynamically stable children with elevated serum transaminase levels (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) who underwent abdominal computed tomographic (CT) scan for blunt abdominal trauma were reviewed. Nineteen patients (44.2%) had AST levels greater than 450 IU/L and ALT levels greater than 250 IU/L, and 17 of these 19 patients had hepatic injury identified on abdominal CT scan. Of the 43 patients, 25 (58.1%) had AST and ALT levels of less than 450 IU/L and 250 IU/L, respectively, and none of these patients had evidence of hepatic injury on CT scan. Elevated serum transaminase levels (AST greater than 450 IU/L and ALT greater than 250 IU/L) identified all of the patients with hepatic injury visible on abdominal CT scan. The sensitivity and specificity of elevated serum transaminase levels were 100% and 92.3%, respectively, for predicting hepatic injury. It is recommended that hemodynamically stable pediatric patients with blunt abdominal trauma and AST levels greater than 450 IU/L and/or ALT levels greater than 250 IU/L undergo abdominal CT scan to determine the presence and extent of hepatic injury. Children with serum transaminase levels below these values are at decreased risk of liver injury.
Hennes
H M
HM
Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53201.
Smith
D S
DS
Schneider
K
K
Hegenbarth
M A
MA
Duma
M A
MA
Jona
J Z
JZ
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002648:Child; D004796:Clinical Enzyme Tests; D004630:Emergencies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000293:injuries*; D011379:Prognosis; D011860:Radiography, Abdominal; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014922:Wisconsin / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase