Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma.
BACKGROUND
The current standard for the evaluation of children with blunt abdominal trauma (BAT) consists of physical examination, screening lab values, and computed tomography (CT) scan. We sought to determine if the focused assessment with sonography for trauma (FAST) combined with elevated liver transaminases (AST/ALT) could be used as a screening tool for intra-abdominal injury (IAI) in pediatric patients with BAT.


METHODS
Registry data at a level 1 trauma center was retrospectively reviewed from 1991-2007. Data collected on BAT patients under the age of 16 y included demographics, injury mechanism, ISS, GCS, imaging studies, serum ALT and AST levels, and disposition. AST and ALT were considered positive if either one was >100 IU/L.


RESULTS
Overall, 3171 cases were identified. A total of 1008 (31.8%) patients received CT scan, 1148 (36.2%) had FAST, and 497 (15.7%) patients received both. Of the 497 patients, 400 (87.1%) also had AST and ALT measured. FAST was 50% sensitive, 91% specific, with a positive predictive value (PPV) of 68%, negative predictive value (NPV) of 83%, and accuracy of 80%. Combining FAST with elevated AST or ALT resulted in a statistically significant increase in all measures (sensitivity 88%, specificity 98%, PPV 94%, NPV 96%, accuracy 96%).


CONCLUSIONS
FAST combined with AST or ALT > 100 IU/L is an effective screening tool for IAI in children following BAT. Pediatric patients with a negative FAST and liver transaminases < 100 IU/L should be observed rather than subjected to the radiation risk of CT.
Sola
Juan E
JE
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Florida, USA. jsola@med.miami.edu
Cheung
Michael C
MC
Yang
Relin
R
Koslow
Starr
S
Lanuti
Emma
E
Seaver
Chris
C
Neville
Holly L
HL
Schulman
Carl I
CI
D000007:Abdominal Injuries / Q000097:blood / Q000175:diagnosis*; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000175:diagnosis*
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase