title: Serum lipase for assessment of pancreatic trauma.
abstract: OBJECTIVE
  Pancreatic enzymes are routinely measured during reception of trauma patients to assess for pancreatic injury despite conflicting evidence on their utility. The aim of this study was to investigate the utility of routine initial serum lipase measurement for the diagnosis of acute pancreatic trauma.
  
  
  METHODS
  Lipase measurements were introduced as part of the trauma pathology panel and requested on all patients who presented to an adult major trauma service and met trauma call-out criteria. Clinical records of these patients were extracted from the trauma registry and retrospectively reviewed. The performance of an initial serum lipase level measured on presentation to detect pancreatic trauma was determined.
  
  
  RESULTS
  There were 2,580 patients included in the study, with 17 patients diagnosed with pancreatic trauma. An elevated lipase was recorded in 390 patients. Statistically significant associations were observed for elevated lipase in patients with pancreatic trauma, head injury, acute alcohol ingestion and massive blood transfusion. As a test for pancreatic trauma, an abnormal serum lipase result had a specificity of 85.3 % (95 % CI 83.8-86.6), sensitivity of 76.5 % (95 % CI 49.8-92.2), positive predictive value of 3.3 % (95 % CI 1.8-5.8) and negative predictive value of 99.8 % (95 % CI 99.4-99.9). Higher cut-offs of serum lipase did not result in better performance.
  
  
  CONCLUSIONS
  A normal serum lipase result can be a useful adjunct to exclude pancreatic injury. A positive lipase result, regardless of the cut-off used, was not reliably associated with pancreatic trauma, and should not be used to guide further assessment.
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia. b.mitra@alfred.org.au.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. b.mitra@alfred.org.au.|National Trauma Research Institute, Melbourne, Australia. b.mitra@alfred.org.au.
authors.forename: B
authors.initials: B
authors.lastname: Mitra
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia.|National Trauma Research Institute, Melbourne, Australia.|Trauma Service, The Alfred Hospital, Melbourne, Australia.|Central Clinical School, Monash University, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Fitzgerald
authors.affiliation: Trauma Service, The Alfred Hospital, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Raoofi
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia.|Central Clinical School, Monash University, Melbourne, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Tan
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia.
authors.forename: J C
authors.initials: JC
authors.lastname: Spencer
authors.affiliation: Trauma Service, The Alfred Hospital, Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Atkin
keywords: Abdomen; Hematologic tests; Pancreas; Resuscitation; Tomography; Wounds and injuries; X-Ray computed
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