title: Utility of hepatic transaminases in children with concern for abuse.
abstract: OBJECTIVE
  Routine testing of hepatic transaminases, amylase, and lipase has been recommended for all children evaluated for physical abuse, but rates of screening are widely variable, even among abuse specialists, and data for amylase and lipase testing are lacking. A previous study of screening in centers that endorsed routine transaminase screening suggested that using a transaminase threshold of 80 IU/L could improve injury detection. Our objectives were to prospectively validate the test characteristics of the 80-IU/L threshold and to determine the utility of amylase and lipase to detect occult abdominal injury.
  
  
  METHODS
  This was a retrospective secondary analysis of the Examining Siblings To Recognize Abuse research network, a multicenter study in children younger than 10 years old who underwent subspecialty evaluation for physical abuse. We determined rates of identified abdominal injuries and results of transaminase, amylase, and lipase testing. Screening studies were compared by using basic test characteristics (sensitivity, specificity) and the area under the receiver operating characteristic curve.
  
  
  RESULTS
  Abdominal injuries were identified in 82 of 2890 subjects (2.8%; 95% confidence interval: 2.3%-3.5%). Hepatic transaminases were obtained in 1538 (53%) subjects. Hepatic transaminases had an area under the receiver operating characteristic curve of 0.87. A threshold of 80 IU/L yielded sensitivity of 83.8% and specificity of 83.1%. The areas under the curve for amylase and lipase were 0.67 and 0.72, respectively.
  
  
  CONCLUSIONS
  Children evaluated for physical abuse with transaminase levels >80 IU/L should undergo definitive testing for abdominal injury.
authors: Department of Emergency Medicine, Brigham & Women's Hospital, 75 Francis St, Neville House, Boston, MA 02132, USA. dlindberg@partners.org
authors: Daniel M
authors: DM
authors: Lindberg
authors: Robert A
authors: RA
authors: Shapiro
authors: Emily A
authors: EA
authors: Blood
authors: R Daryl
authors: RD
authors: Steiner
authors: Rachel P
authors: RP
authors: Berger
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000201:enzymology* / Q000453:epidemiology; D000681:Amylases / Q000097:blood*; D019540:Area Under Curve; D001900:Boston; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood*; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood*
chemical_list: D000637:Transaminases; D008049:Lipase; D000681:Amylases