A Reliable Screening Test to Predict Liver Injury in Pediatric Blunt Torso Trauma

We determined the validity of serumaspartate aminotransferase (AST) and alanine aminotransferase(ALT) as screening tests in the identificationof liver injuries in pediatric torso trauma patients.

We conducted a retrospective study inpediatric patients < 17 years of age who sustainedblunt trauma and were admitted to an urban traumacenter during a 39-month period. The serum AST andALT levels, injury severity scores (ISS), lengths of hospitaland intensive care unit stays, laparotomy andvascular embolization requirement, mortality rate, andconcomitant injuries were compared betweenpatients with and without liver injury.

Of the 40 patients reviewed, 16 patients hadliver injuries. The mean serum AST and ALT levels weremarkedly higher in the liver injury (LI) group than inthe non-liver injury (NLI) group (773.4 IU/l ± 781.3 [SD]and 613.6 IU/l ± 640.0 [SD], respectively, and (67.2IU/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 NLIpatients had AST levels < 200 IU/l or ALT levels < 125IU/l. The sensitivity, specificity, and positive and negativepredictive values were 94, 83, 79, and 95%,respectively.

A serum AST > 200 IU/l or an ALT> 125 IU/l are strong predictors of liver injury in childrensustaining blunt torso trauma. We recommend theroutine use of serum transaminase levels as screeningtests in hemodynamically stable patients.