PURPOSE: 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. CONCLUSION: 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.
PURPOSE: 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. CONCLUSION: 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: E E Moore; S R Shackford; H L Pachter; J W McAninch; B D Browner; H R Champion; L M Flint; T A Gennarelli; M A Malangoni; M L Ramenofsky Journal: J Trauma Date: 1989-12
Authors: James F Holmes; Peter E Sokolove; William E Brant; Michael J Palchak; Cheryl W Vance; John T Owings; Nathan Kuppermann Journal: Ann Emerg Med Date: 2002-05 Impact factor: 5.721
Authors: James F Holmes; Kathleen Lillis; David Monroe; Dominic Borgialli; Benjamin T Kerrey; Prashant Mahajan; Kathleen Adelgais; Angela M Ellison; Kenneth Yen; Shireen Atabaki; Jay Menaker; Bema Bonsu; Kimberly S Quayle; Madelyn Garcia; Alexander Rogers; Stephen Blumberg; Lois Lee; Michael Tunik; Joshua Kooistra; Maria Kwok; Lawrence J Cook; J Michael Dean; Peter E Sokolove; David H Wisner; Peter Ehrlich; Arthur Cooper; Peter S Dayan; Sandra Wootton-Gorges; Nathan Kuppermann Journal: Ann Emerg Med Date: 2013-02-01 Impact factor: 5.721
Authors: Prashant Mahajan; Nathan Kuppermann; Michael Tunik; Kenneth Yen; Shireen M Atabaki; Lois K Lee; Angela M Ellison; Bema K Bonsu; Cody S Olsen; Larry Cook; Maria Y Kwok; Kathleen Lillis; James F Holmes Journal: Acad Emerg Med Date: 2015-08-20 Impact factor: 3.451
Authors: Smita Awasthi; Amy Mao; Sandra L Wooton-Gorges; David H Wisner; Nathan Kuppermann; James F Holmes Journal: Acad Emerg Med Date: 2008-09-05 Impact factor: 3.451
Authors: Adam P Sigal; Traci Deaner; Sam Woods; Elizabeth Mannarelli; Alison L Muller; Anthony Martin; Alexis Schoener; McKenna Brower; Adrian Ong; Thomas Geng; Felipe Guillen; Brian Lahmann; Tom Wasser; Christopher Valente Journal: J Am Coll Emerg Physicians Open Date: 2022-01-15