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Utility Of Screen Tests To Predict Clinically Relevant Liver Injuries
*Marla Ashley Sacks1, Ethan Miles2, Emily Gunderson2, Yomara S Mendez1, John Tan1, Laura Goodman1, Asra Hasmi3, Andrei Radulescu1, Faraz A Khan1
1Loma Linda University Children's Hospital, Loma Linda, CA;2Loma Linda University School of Medicine, Loma Linda, CA;3Loma Linda University Medical Center, Loma Linda, CA

BACKGROUND: Trauma is the leading cause of disability and death in children. Computed tomography(CT) imaging is the gold standard to detect clinically significant intrabdominal injuries, but to limit unnecessary CT and radiation exposure, screening labs are used. This study aimed to identify liver function test(LFT) thresholds predicting clinically significant solid organ injuries.METHODS: After IRB approval, a retrospective analysis of pediatric trauma patients(0-18years) with blunt injuries treated at a level 1 pediatric trauma center between January 2014 - December 2019 was performed. Patients having abdominal CT scans and LFT were included, clinically significant liver injuries(AAST grade &gt/=3) were compared to those without solid organ injuries.FINDINGS: Of the 555 pediatric trauma patients reviewed, 329 met the inclusion criteria. There were 208 males(63.2%) with median age 11.01 years and injury severity score(ISS) 17. Injuries noted were 90 liver, 36 kidney, 71 spleen, 33 bowel, 14 pancreas, 9 adrenal. The median AST and ALT values were significantly higher in severe liver injuries: 650 vs 58 and 493 vs. 42units/L(p &lt 0.00001) respectively. Receiver Operating Curve analysis identified optimal ALT and AST threshold values predicting clinically significant liver injuries {AST(AUC=0.9602, p &lt 0.0001) at 211.5units/L and ALT(AUC=0.9812, p &lt 0.0001) at 128 units/L} (figure 1).CONCLUSIONS: For hemodynamically stable blunt abdominal trauma patients, clinically significant liver injuries are likely when AST and ALT are greater than 211.5 and 128units/L respectively and these threshold values should trigger an abdominal CT scan.


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