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Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study

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 alternat...

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Autores principales: Bruhn, Peter James, Østerballe, Lene, Hillingsø, Jens, Svendsen, Lars Bo, Helgstrand, Frederik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000516/
https://www.ncbi.nlm.nih.gov/pubmed/27561373
http://dx.doi.org/10.1186/s13049-016-0297-1
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author Bruhn, Peter James
Østerballe, Lene
Hillingsø, Jens
Svendsen, Lars Bo
Helgstrand, Frederik
author_facet Bruhn, Peter James
Østerballe, Lene
Hillingsø, Jens
Svendsen, Lars Bo
Helgstrand, Frederik
author_sort Bruhn, Peter James
collection PubMed
description 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. DISCUSSION: 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.
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spelling pubmed-50005162016-08-27 Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study Bruhn, Peter James Østerballe, Lene Hillingsø, Jens Svendsen, Lars Bo Helgstrand, Frederik Scand J Trauma Resusc Emerg Med Original Research 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. DISCUSSION: 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. BioMed Central 2016-08-25 /pmc/articles/PMC5000516/ /pubmed/27561373 http://dx.doi.org/10.1186/s13049-016-0297-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research
Bruhn, Peter James
Østerballe, Lene
Hillingsø, Jens
Svendsen, Lars Bo
Helgstrand, Frederik
Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study
title Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study
title_full Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study
title_fullStr Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study
title_full_unstemmed Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study
title_short Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study
title_sort posttraumatic levels of liver enzymes can reduce the need for ct in children: a retrospective cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000516/
https://www.ncbi.nlm.nih.gov/pubmed/27561373
http://dx.doi.org/10.1186/s13049-016-0297-1
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