Pediatric FAST and Elevated Liver Transaminases

An Effective Screening Tool in Blunt Abdominal Trauma

Juan E Sola, Michael C. Cheung, Relin Yang, Starr Koslow, Emma Lanuti, Chris Seaver, Holly Neville, Carl I Schulman

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: The current standard for the evaluation of children with blunt abdominal trauma (BAT) consists of physical examination, screening lab values, and computed tomography (CT) scan. We sought to determine if the focused assessment with sonography for trauma (FAST) combined with elevated liver transaminases (AST/ALT) could be used as a screening tool for intra-abdominal injury (IAI) in pediatric patients with BAT. Methods: Registry data at a level 1 trauma center was retrospectively reviewed from 1991-2007. Data collected on BAT patients under the age of 16 y included demographics, injury mechanism, ISS, GCS, imaging studies, serum ALT and AST levels, and disposition. AST and ALT were considered positive if either one was >100 IU/L. Results: Overall, 3171 cases were identified. A total of 1008 (31.8%) patients received CT scan, 1148 (36.2%) had FAST, and 497 (15.7%) patients received both. Of the 497 patients, 400 (87.1%) also had AST and ALT measured. FAST was 50% sensitive, 91% specific, with a positive predictive value (PPV) of 68%, negative predictive value (NPV) of 83%, and accuracy of 80%. Combining FAST with elevated AST or ALT resulted in a statistically significant increase in all measures (sensitivity 88%, specificity 98%, PPV 94%, NPV 96%, accuracy 96%). Conclusions: FAST combined with AST or ALT > 100 IU/L is an effective screening tool for IAI in children following BAT. Pediatric patients with a negative FAST and liver transaminases < 100 IU/L should be observed rather than subjected to the radiation risk of CT.

Original languageEnglish
Pages (from-to)103-107
Number of pages5
JournalJournal of Surgical Research
Volume157
Issue number1
DOIs
StatePublished - Nov 1 2009

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Transaminases
Ultrasonography
Pediatrics
Liver
Wounds and Injuries
Abdominal Injuries
Tomography
Trauma Centers
Physical Examination
Registries
Demography
Radiation
Sensitivity and Specificity

Keywords

  • blunt abdominal trauma
  • children
  • FAST
  • screening

ASJC Scopus subject areas

  • Surgery

Cite this

Pediatric FAST and Elevated Liver Transaminases : An Effective Screening Tool in Blunt Abdominal Trauma. / Sola, Juan E; Cheung, Michael C.; Yang, Relin; Koslow, Starr; Lanuti, Emma; Seaver, Chris; Neville, Holly; Schulman, Carl I.

In: Journal of Surgical Research, Vol. 157, No. 1, 01.11.2009, p. 103-107.

Research output: Contribution to journalArticle

Sola, Juan E ; Cheung, Michael C. ; Yang, Relin ; Koslow, Starr ; Lanuti, Emma ; Seaver, Chris ; Neville, Holly ; Schulman, Carl I. / Pediatric FAST and Elevated Liver Transaminases : An Effective Screening Tool in Blunt Abdominal Trauma. In: Journal of Surgical Research. 2009 ; Vol. 157, No. 1. pp. 103-107.
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abstract = "Background: The current standard for the evaluation of children with blunt abdominal trauma (BAT) consists of physical examination, screening lab values, and computed tomography (CT) scan. We sought to determine if the focused assessment with sonography for trauma (FAST) combined with elevated liver transaminases (AST/ALT) could be used as a screening tool for intra-abdominal injury (IAI) in pediatric patients with BAT. Methods: Registry data at a level 1 trauma center was retrospectively reviewed from 1991-2007. Data collected on BAT patients under the age of 16 y included demographics, injury mechanism, ISS, GCS, imaging studies, serum ALT and AST levels, and disposition. AST and ALT were considered positive if either one was >100 IU/L. Results: Overall, 3171 cases were identified. A total of 1008 (31.8{\%}) patients received CT scan, 1148 (36.2{\%}) had FAST, and 497 (15.7{\%}) patients received both. Of the 497 patients, 400 (87.1{\%}) also had AST and ALT measured. FAST was 50{\%} sensitive, 91{\%} specific, with a positive predictive value (PPV) of 68{\%}, negative predictive value (NPV) of 83{\%}, and accuracy of 80{\%}. Combining FAST with elevated AST or ALT resulted in a statistically significant increase in all measures (sensitivity 88{\%}, specificity 98{\%}, PPV 94{\%}, NPV 96{\%}, accuracy 96{\%}). Conclusions: FAST combined with AST or ALT > 100 IU/L is an effective screening tool for IAI in children following BAT. Pediatric patients with a negative FAST and liver transaminases < 100 IU/L should be observed rather than subjected to the radiation risk of CT.",
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AU - Seaver, Chris

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