Pediatric Liver Injury

Physical Examination, Fast and Serum Transaminases Can Serve as a Guide

Muhammad Zeeshan, Mohammad Hamidi, Terence OKeeffe, Kamil Hanna, Narong Kulvatunyou, Andrew Tang, Bellal Joseph

Research output: Contribution to journalArticle

Abstract

Background: The aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST)would effectively rule out major hepatic injuries (HIs)after blunt abdominal trauma (BAT)in hemodynamically stable pediatric patients. Methods: We conducted a 9-year retrospective study of pediatric patients (<18 y)with BAT. We collected data on liver enzymes (aspartate transaminase [AST]and alanine transaminase [ALT]), FAST, and PE findings. Definitive diagnosis and staging of HI were based on abdominal CT scanning. The sensitivity and specificity of ALT/AST, FAST, and PE were then calculated individually and in combination. Results: We identified a total of 423 pediatric patients with BAT. Mean age was 11 y, median abdominal Abbreviated Injury Scale was 3 [2-4], and mean ED-SBP was 132 mm Hg. One hundred ninety-eight patients had HI of which 107 were major HI, defined by the American Association for the Surgery of Trauma as ≥grade III. Using ROC curve analysis, optimum ALT and AST thresholds were determined to be 90 U/L and 120 U/L, respectively. The sensitivity of FAST was 50% while that of PE was 40%. Combining PE with AST/ALT and FAST had an overall sensitivity of 97%, a specificity of 95%, a positive predictive value of 87%, and a negative predictive value of 98%. Conclusions: In hemodynamically stable pediatric blunt abdominal trauma patients, CT scanning can be avoided using a combination of readily available tests thus avoiding unnecessary radiation exposure. However, pediatric patients with positive PE, FAST, and elevated AST/ALT may eventually require CT scan to further evaluate liver injuries.

Original languageEnglish (US)
Pages (from-to)151-156
Number of pages6
JournalJournal of Surgical Research
Volume242
DOIs
StatePublished - Oct 1 2019

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Transaminases
Physical Examination
Pediatrics
Liver
Wounds and Injuries
Serum
Aspartate Aminotransferases
Ultrasonography
Alanine Transaminase
ROC Curve
Abbreviated Injury Scale
Abdominal Injuries
Nonpenetrating Wounds
Retrospective Studies

Keywords

  • Diagnostic modalities
  • Liver injuries
  • Pediatric trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Pediatric Liver Injury : Physical Examination, Fast and Serum Transaminases Can Serve as a Guide. / Zeeshan, Muhammad; Hamidi, Mohammad; OKeeffe, Terence; Hanna, Kamil; Kulvatunyou, Narong; Tang, Andrew; Joseph, Bellal.

In: Journal of Surgical Research, Vol. 242, 01.10.2019, p. 151-156.

Research output: Contribution to journalArticle

Zeeshan, Muhammad ; Hamidi, Mohammad ; OKeeffe, Terence ; Hanna, Kamil ; Kulvatunyou, Narong ; Tang, Andrew ; Joseph, Bellal. / Pediatric Liver Injury : Physical Examination, Fast and Serum Transaminases Can Serve as a Guide. In: Journal of Surgical Research. 2019 ; Vol. 242. pp. 151-156.
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abstract = "Background: The aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST)would effectively rule out major hepatic injuries (HIs)after blunt abdominal trauma (BAT)in hemodynamically stable pediatric patients. Methods: We conducted a 9-year retrospective study of pediatric patients (<18 y)with BAT. We collected data on liver enzymes (aspartate transaminase [AST]and alanine transaminase [ALT]), FAST, and PE findings. Definitive diagnosis and staging of HI were based on abdominal CT scanning. The sensitivity and specificity of ALT/AST, FAST, and PE were then calculated individually and in combination. Results: We identified a total of 423 pediatric patients with BAT. Mean age was 11 y, median abdominal Abbreviated Injury Scale was 3 [2-4], and mean ED-SBP was 132 mm Hg. One hundred ninety-eight patients had HI of which 107 were major HI, defined by the American Association for the Surgery of Trauma as ≥grade III. Using ROC curve analysis, optimum ALT and AST thresholds were determined to be 90 U/L and 120 U/L, respectively. The sensitivity of FAST was 50{\%} while that of PE was 40{\%}. Combining PE with AST/ALT and FAST had an overall sensitivity of 97{\%}, a specificity of 95{\%}, a positive predictive value of 87{\%}, and a negative predictive value of 98{\%}. Conclusions: In hemodynamically stable pediatric blunt abdominal trauma patients, CT scanning can be avoided using a combination of readily available tests thus avoiding unnecessary radiation exposure. However, pediatric patients with positive PE, FAST, and elevated AST/ALT may eventually require CT scan to further evaluate liver injuries.",
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