The clinical significance of acute hyperamylasemia after blunt trauma

The clinical value of total serum amylase (TSA) levels measured after blunt trauma remains controversial. To test the utility of this measurement, the authors surveyed the routine admission TSA levels of 4316 adults who were victims of blunt trauma. Most patients (58.2%) had been injured in motor vehicle accidents, and all were admitted directly from the accident scene. Patients were divided into two groups based on the admission TSA level: more than 125 U/L (abnormal) and 125 U/L or less (normal). Of the 4316 patients, 3920 (90.8%) had a normal TSA level upon admission. Hyperamylasemia was associated with a greater injury severity score (ISS) and death rate, a lower admission Glasgow Coma Scale score and an increased incidence of facial fracture, brain injury, pancreatic and hollow-viscus injuries and hypotension (p < 0.01). However, the positive predictive value of an abnormal TSA level for pancreatic and hollow-viscus injuries was 1.5% and 3.0% respectively. Also, most patients with pancreatic (65%) and hollow-viscus (83%) injuries had a normal TSA level. There was no relation between the anatomic grade of pancreatic injury and the TSA level. Acute hyperamylasemia after blunt trauma appears to be a poor predictor of pancreatic and hollow-viscus injuries. Therefore, urgent TSA determinations should not influence the clinical and radiologic evaluation of the blunt trauma victim.