title: Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study.
abstract: BACKGROUND
  Computed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, the adverse effects of radiation exposure are of specific concern in the pediatric population. It is therefore desirable to explore alternative diagnostic modalities. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are hepatic enzymes, which are elevated in peripheral blood in relation to liver injury. The aim of the present study was to investigate a potential role of normal liver transaminase levels in the decision algorithm in suspected pediatric blunt liver trauma.
  
  
  METHODS
  Retrospective analysis of consecutively collected data from children (0-17 years) with blunt liver trauma, admitted to a single trauma centre in Denmark, between 2000 and 2013. Patients underwent abdominal CT during initial evaluation, and initial AST and/or ALT was measured. Based on local guidelines, we set the threshold for blood AST and ALT level to 50 IU/L. Nonparametric statistical tests were used.
  
  
  RESULTS
  Sixty consecutive children with liver injury following blunt abdominal trauma were enrolled in the study. All patients with normal AST and/or ALT level were treated conservatively with success. Information on both AST and ALT was available in 47 children. Of these 47 children, three children had AST and ALT levels ≤50 IU/L. These children suffered from grade I liver injuries, and were treated conservatively with no complications.
  
  
  CONCLUSIONS
  All children who presented with blunt liver injury and AST and ALT levels ≤50 IU/L did not require treatment. These findings indicate that AST and ALT could be included in an updated management algorithm as a screening method to avoid abdominal CT. Notable limitations to the study was the retrospective method of data collection, without inclusion of a control group.
  
  
  CONCLUSIONS
  CT seems superfluous in the initial evaluation of hemodynamically stable children with suspected blunt liver injury and blood AST and ALT levels ≤50 IU/L.
authors: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. peterjamesbruhn@gmail.com.
authors: Peter James
authors: PJ
authors: Bruhn
authors: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
authors: Lene
authors: L
authors: Østerballe
authors: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
authors: Jens
authors: J
authors: Hillingsø
authors: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
authors: Lars Bo
authors: LB
authors: Svendsen
authors: Department of Surgical Gastroenterology, Køge Hospital, University of Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.
authors: Frederik
authors: F
authors: Helgstrand
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002648:Child; D003718:Denmark; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Blunt liver injury; Computed tomography; Liver transaminases; Pediatric liver injury