Utility of Hepatic Transaminases in Children With Concern for Abuse
Utility of Hepatic Transaminases in Children With Concern for Abuse
复制标题
肝转氨酶在担心虐待的儿童中的作用
作者：
D. Lindberg;R. Shapiro;E. Blood;R. Steiner;R. Berger
目的：肝转氨酶、淀粉酶和脂肪酶的常规检测已被推荐给所有被评估为身体虐待的儿童，但筛查率差异很大，即使在虐待专家中也是如此，淀粉酶和脂肪酶检测的数据也很缺乏。先前在支持常规转氨酶筛查的中心进行的一项筛查研究表明，使用80IU/L的转氨酶阈值可以提高损伤检测。我们的目标是前瞻性地验证80-IU/L阈值的测试特征，并确定淀粉酶和脂肪酶在诊断隐性腹部损伤中的作用。方法：这是一项对检查兄弟姐妹识别虐待研究网络的回顾性二次分析，这是一项针对10岁以下接受身体虐待次级专业评估的儿童的多中心研究。我们测定了腹部损伤的确诊率以及转氨酶、淀粉酶和脂肪酶检测结果。筛查研究通过使用基本测试特征(敏感度、特异度)和受试者工作特征曲线下面积进行比较。结果：2890名受试者中有82人发现腹部损伤(2.8%；95%可信区间：2.3%-3.5%)。1538例(53%)受试者获得了转氨酶。肝转氨酶的受试者工作特性曲线下面积为0.87。以80IU/L为临界值，敏感度为83.8%，特异度为83.1%。淀粉酶和脂肪酶的曲线下面积分别为0.67和0.72。结论：转氨酶水平<80IU/L被评估为身体虐待的儿童应该接受腹部损伤的明确检查。
OBJECTIVE: Routine testing of hepatic transaminases, amylase, and lipase has been recommended for all children evaluated for physical abuse, but rates of screening are widely variable, even among abuse specialists, and data for amylase and lipase testing are lacking. A previous study of screening in centers that endorsed routine transaminase screening suggested that using a transaminase threshold of 80 IU/L could improve injury detection. Our objectives were to prospectively validate the test characteristics of the 80-IU/L threshold and to determine the utility of amylase and lipase to detect occult abdominal injury. METHODS: This was a retrospective secondary analysis of the Examining Siblings To Recognize Abuse research network, a multicenter study in children younger than 10 years old who underwent subspecialty evaluation for physical abuse. We determined rates of identified abdominal injuries and results of transaminase, amylase, and lipase testing. Screening studies were compared by using basic test characteristics (sensitivity, specificity) and the area under the receiver operating characteristic curve. RESULTS: Abdominal injuries were identified in 82 of 2890 subjects (2.8%; 95% confidence interval: 2.3%–3.5%). Hepatic transaminases were obtained in 1538 (53%) subjects. Hepatic transaminases had an area under the receiver operating characteristic curve of 0.87. A threshold of 80 IU/L yielded sensitivity of 83.8% and specificity of 83.1%. The areas under the curve for amylase and lipase were 0.67 and 0.72, respectively. CONCLUSIONS: Children evaluated for physical abuse with transaminase levels >80 IU/L should undergo definitive testing for abdominal injury.