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Feng-Yuan Chu, Hung-Jung Lin, How-Ran Guo, Tsan-Hsing Liu, Ning-Ping Foo,
Kuo-Tai Chen |
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Objectives: We determined the validity of serum
aspartate aminotransferase (AST) and alanine aminotransferase
(ALT) as screening tests in the identification
of liver injuries in pediatric torso trauma patients.
Methods: We conducted a retrospective study in
pediatric patients < 17 years of age who sustained
blunt trauma and were admitted to an urban trauma
center during a 39-month period. The serum AST and
ALT levels, injury severity scores (ISS), lengths of hospital
and intensive care unit stays, laparotomy and
vascular embolization requirement, mortality rate, and
concomitant injuries were compared between
patients with and without liver injury.
Results: Of the 40 patients reviewed, 16 patients had
liver injuries. The mean serum AST and ALT levels were
markedly higher in the liver injury (LI) group than in
the non-liver injury (NLI) group (773.4 IU/l ± 781.3 [SD]
and 613.6 IU/l ± 640.0 [SD], respectively, and (67.2
IU/l ± 63.2 [SD] and 55.5 IU/l ± 62.6 [SD], respectively;
p < 0.01). One of the 16 LI patients and 20 of the 24 NLI
patients had AST levels < 200 IU/l or ALT levels < 125
IU/l. The sensitivity, specificity, and positive and negative
predictive values were 94, 83, 79, and 95%,
respectively.
Conclusions: A serum AST > 200 IU/l or an ALT
> 125 IU/l are strong predictors of liver injury in children
sustaining blunt torso trauma. We recommend the
routine use of serum transaminase levels as screening
tests in hemodynamically stable patients. |
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