title: Re-evaluation of liver transaminase cutoff for CT after pediatric blunt abdominal trauma.
abstract: OBJECTIVE
  Current guidelines for computed tomography (CT) after blunt trauma were developed to capture all intra-abdominal injuries (IAI). We hypothesize that current AST/ALT guidelines are too low leading to unnecessary CT scans for children after blunt abdominal trauma (BAT).
  
  
  METHODS
  Patients who received CT of the abdomen after blunt trauma at our Level I Pediatric Trauma Center were stratified into a high risk (HR) (liver/spleen/kidney grade ≥III, hollow viscous, or pancreatic injuries) and low risk (LR) (liver/kidney/spleen injuries grade ≤II, or no IAI) groups.
  
  
  RESULTS
  247 patients were included. Of the 18 patients in the HR group, two required surgery (splenectomy and sigmoidectomy). Transfusion was required in 30% of grade III and 50% of grade IV injuries. Eleven (5%) patients in LR group were transfused for indications other than IAI, and none were explored surgically. Both AST (r = 0.44, p < 0.001) and ALT (r = 0.43, p < 0.001) correlated with grade of liver injury. Using an increased threshold of AST/ALT, 400/200 had a negative predictive value of 96% in predicting the presence of HR liver injuries.
  
  
  CONCLUSIONS
  The current cutoff of liver enzymes leads to over-identification of LR injuries. Consideration should be given to an approach that aims to utilize CT in pediatric BAT that identifies clinically HR injury.
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Zagory
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA.
authors.forename: Avafia
authors.initials: A
authors.lastname: Dossa
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Golden
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Jensen
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Goodhue
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Upperman
authors.affiliation: Children's Hospital Los Angeles, 4650 W Sunset Blvd, MS 100, Los Angeles, CA, 90027, USA. cgayer@chla.usc.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gayer
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000007:Abdominal Injuries / Q000097:blood* / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D000637:Transaminases / Q000097:blood*; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000000981:diagnostic imaging*
chemical_list: D000637:Transaminases
keywords: ALT; AST; Blunt abdominal trauma; Computed tomography; Pediatric trauma