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Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma

William T Adamson1, Andre Hebra, Patrick B Thomas

  • 1Department of Surgery, Division of Pediatric Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

Journal of Pediatric Surgery
|March 13, 2003
PubMed

Insights

Serum amylase and lipase tests are not reliable or cost-effective for screening pediatric pancreatic trauma. Elevated levels often lead to unnecessary imaging, increasing healthcare costs without confirming injury.

Area of Science:

  • Pediatric Trauma Surgery
  • Gastrointestinal Radiology
  • Biochemical Diagnostics

Background:

  • Pancreatic injury is uncommon in pediatric trauma cases.
  • Diagnosis relies on clinical signs, imaging, and labs, but serum markers lack strong correlation.
  • This study evaluates the utility and cost-effectiveness of serum amylase and lipase in pediatric pancreatic injury.

Purpose of the Study:

  • To assess the diagnostic value of serum amylase and lipase levels in pediatric trauma patients.
  • To determine the cost-effectiveness of using these serum markers for screening pancreatic injuries.
  • To analyze the impact of elevated serum amylase/lipase on subsequent diagnostic imaging.

Main Methods:

  • Retrospective analysis of 1,821 pediatric trauma patients over 64 months.
  • Identified 8 cases of pancreatic injury among 195 patients with intra-abdominal trauma.
  • Correlated serum amylase/lipase (AMY/LIP) levels with confirmed pancreatic injuries and diagnostic imaging findings.

Main Results:

  • Serum AMY/LIP measured in 507 patients; 116 (23%) had elevated levels.
  • Five of eight patients with pancreatic injury had elevated AMY/LIP.
  • Elevated AMY/LIP levels in 48% of patients without intra-abdominal injury, leading to unnecessary CT scans ($592/scan).

Conclusions:

  • Serum amylase and lipase can support clinical suspicion but are unreliable screening tools for pediatric pancreatic trauma.
  • Routine use of these tests and subsequent imaging is not cost-effective and may be unjustified.
  • Clinical evaluation remains paramount in diagnosing pancreatic injuries in pediatric trauma.
Abstract

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