S. F. Rosati1, B. A. Borg1, P. Kato1, A. Husseini1, L. Donoghue1, C. Shanti1 1Children’s Hospital Of Michigan,Pediatric Surgery,Detroit, MI, USA
Introduction: Injury is the leading cause of morbidity and mortality in children over one year; over 90% are the result of blunt trauma. Diagnostic aids to detect intra-abdominal injuries (IAIs) of the liver and spleen include abdomen/pelvis CT scans (AP CT) and liver function tests (LFTs). Historically, elevated LFTs have been used as a marker for when to obtain AP CTs. Our objectives were to evaluate the number of clinically significant injuries (defined as Grade IV or V) found using AP CT, and if there was a correlation to elevated LFTs.
Methods: This is a retrospective review of pediatric patients (<18 years) evaluated at our Pediatric Level I trauma center from 1/1/15-12/31/16, who suffered blunt trauma. Variables included age, gender, injury severity score (ISS), LFTs, AP CTs and IAI with grades.
Results: 1138 children were evaluated: 63% male, 37% female, with ages from 6 wks – 18 yrs (mean 5.25 yrs) and ISS from 0-45 (mean 5.4). 38% of patients (pts) had LFTs, 5% had an AP CT, 37% had IAI (1.8% overall). In the 62% of pts without LFTs, there were 16 AP CTs, 4 IAI, 0 significant; in pts with LFTs 0-100 (33%), there were 27 AP CTs, 7 IAI, 1 significant; in pts with LFTs 101-200 (2.8%), there were 7 AP CTs, 1 IAI, not significant; in pts with LFTs 201-300 (0.8%), there were 6 AP CTs, 5 IAI, 0 significant; in pts with LFTs 301-400 (0.4%), there were 2 AP CTs, 1 IAI, significant; in pts with LFTs 401-500 (0.01%), there was 1 AP CT, 1 IAI, not significant; in pts with LFTs > 500 (0.7%), there were 8 AP CTs, 2 IAI, 0 significant.
Conclusion: In this limited review, a fraction of pts required an AP CT. While 33% of them were found to have IAI on CT, only 1% was clinically significant. Elevated LFTs do not correlate with the severity of IAI. LFTs alone may be a poor screening lab to determine need for an AP CT. We propose developing a different screening approach to our pts besides LFTs to determine need for AP CT.
