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Liver function tests in children with blunt abdominal traumas
O Karam1, G La Scala, C Le Coultre
1Paediatric Surgery Clinic, University of Geneva Children's Hospital, Geneva, Switzerland.
Insights
In children with blunt abdominal trauma, low liver function tests (LFTs) do not reliably exclude significant liver injury. Clinical and radiological findings remain crucial for diagnosing liver damage.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Hepatology
Background:
- Previous research suggested specific cut-off values for liver function tests (LFTs) to rule out liver injury after blunt abdominal trauma in children.
- The diagnostic utility of these LFT cut-offs in pediatric blunt abdominal trauma requires further validation.
Purpose of the Study:
- To evaluate the reliability of pre-defined liver function test (LFT) cut-off values in excluding significant liver injury in pediatric patients following blunt abdominal trauma.
- To determine if established LFT thresholds can safely rule out liver injury in this specific patient population.
Main Methods:
- A retrospective analysis of consecutive pediatric patients admitted with blunt abdominal trauma between 2001 and 2004.
- Comparison of liver function test (LFT) results with radiological findings (ultrasound, CT scan) and patient outcomes.
- Statistical analysis to assess the significance of LFT variations between injured and uninjured patients.
Main Results:
- Sixteen out of 115 patients showed radiological evidence of liver injury.
- Patients with liver injury had significantly elevated AST and ALT levels compared to those without injury (p < 0.01).
- A notable proportion of patients with liver injury had LFT values below previously suggested cut-off levels, including two with Grade 3 injury.
Conclusions:
- Low admission liver function test (LFT) values cannot reliably exclude significant liver injury in pediatric blunt abdominal trauma.
- Diagnosis of liver injury in pediatric blunt abdominal trauma depends on clinical assessment and radiological evidence.
- Current LFT cut-off values may not be sufficiently sensitive to rule out liver injury in pediatric blunt abdominal trauma cases.
Background:
Previous studies have suggested that there are cut-off values for liver function tests (LFTs) beneath which significant liver injury can be excluded after blunt abdominal trauma in children. Our objective is to test this hypothesis in our patient population.
Methods:
The LFTs of all consecutive patients admitted in Geneva from January 1, 2001 to December 31, 2004 following blunt abdominal trauma were analysed and compared to radiological (ultrasound and/or computed tomography scan) findings and final outcome.
Results:
Of 115 patients identified, sixteen had radiological evidence of liver injury. These patients had significantly (p < 0.01) increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values (474 +/- 369 IU/l and 442 +/- 383 IU/l, respectively) compared to patients without liver injury (AST 88 +/- 161 IU/l and ALT 68 +/- 137 IU/l). Among the sixteen patients with liver injury, ten (63 %) had AST < 450 IU/l and seven (44 %) had ALT < 250 IU/l. Two patients had radiological evidence of OIS grade 3 liver injury with AST as low as 95 and 92, and ALT of 80 and 86, below all cut-off values recommended in the literature.
Conclusion:
In our experience, low LFT values at admission could not rule out significant liver injury. The diagnosis of such lesions still relies on clinical and radiological findings, as do other intra-abdominal organ injuries.
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