Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration

Lee, Wei-Che; Kuo, Liang-Chi; Cheng, Yuan-Chia; Chen, Chao-Wen; Lin, Yen-Ko; Lin, Tong; Lin, Hsing‐Lin

doi:10.1016/j.ajem.2009.06.005

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…The previous studies analysed pediatric patient data, but had varying focus concerning primary condition leading to CT, whether or not FAST was performed, and which upper liver transaminase reference value was applied. Overall, our results are supported by these previous studies, which indicated that evaluation of liver enzyme levels could indeed be applied as an argument to abstain from emergency abdominal CT [1, 21–27]. Some of these studies showed remarkably high sensitivity and specificity in diagnosing blunt liver injury with application of varying liver enzyme reference ranges [21–23].…”

Section: Discussionsupporting

confidence: 87%

“…Several studies have been performed on the diagnostic capability of evaluation of various threshold levels for AST and ALT [1, 21–27]. The previous studies analysed pediatric patient data, but had varying focus concerning primary condition leading to CT, whether or not FAST was performed, and which upper liver transaminase reference value was applied.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the role of liver transaminase levels and FAST (focused assessment sonography in trauma) in initial diagnostic management of pediatric blunt liver traumas [1, 21–27]. The studies have found that liver transaminase levels as well as FAST are valuable screening tools in the decision algorithm in blunt liver injury.…”

Section: Introductionmentioning

confidence: 99%

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Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study

Bruhn

Østerballe

Hillingsø

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundComputed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, the adverse effects of radiation exposure are of specific concern in the pediatric population. It is therefore desirable to explore alternative diagnostic modalities. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are hepatic enzymes, which are elevated in peripheral blood in relation to liver injury. The aim of the present study was to investigate a potential role of normal liver transaminase levels in the decision algorithm in suspected pediatric blunt liver trauma.MethodsRetrospective analysis of consecutively collected data from children (0–17 years) with blunt liver trauma, admitted to a single trauma centre in Denmark, between 2000 and 2013. Patients underwent abdominal CT during initial evaluation, and initial AST and/or ALT was measured. Based on local guidelines, we set the threshold for blood AST and ALT level to 50 IU/L. Nonparametric statistical tests were used.ResultsSixty consecutive children with liver injury following blunt abdominal trauma were enrolled in the study. All patients with normal AST and/or ALT level were treated conservatively with success. Information on both AST and ALT was available in 47 children. Of these 47 children, three children had AST and ALT levels ≤50 IU/L. These children suffered from grade I liver injuries, and were treated conservatively with no complications.DiscussionAll children who presented with blunt liver injury and AST and ALT levels ≤50 IU/L did not require treatment. These findings indicate that AST and ALT could be included in an updated management algorithm as a screening method to avoid abdominal CT. Notable limitations to the study was the retrospective method of data collection, without inclusion of a control group. ConclusionsCT seems superfluous in the initial evaluation of hemodynamically stable children with suspected blunt liver injury and blood AST and ALT levels ≤50 IU/L.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study

Bruhn

Østerballe

Hillingsø

et al. 2016

Scand J Trauma Resusc Emerg Med

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show abstract

“…Further, there were significant increases in WBC and LDL (Pb + Hg + Cd only) during the 30-day study. Elevated WBC was due to the immune system's response to combat insults from causative agent's [57,58]. High LDL, which may suggest abnormal lipid metabolism, could be oxidized in the form of cholesteryl-linoleate in conditions such as atherosclerosis or inflammatory diseases such as rheumatoid arthritis in humans [59].…”

Section: Discussionmentioning

confidence: 98%

Toxicity assessment due to sub-chronic exposure to individual and mixtures of four toxic heavy metals

Cobbina

Chen

Zhou

et al. 2015

Journal of Hazardous Materials

184

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“…The serum levels of a number of hepatic enzymes behave as diagnostic indicators for hepatic injury (Lee et al, 2010). Increased levels of LDH, AST, ALT and ALP in serum of the HPTM induced animals certainly indicate liver damage.…”

Section: Discussionmentioning

confidence: 99%

Hibiscus vitifolius (Linn.) root extracts shows potent protective action against anti-tubercular drug induced hepatotoxicity

Samuel¹,

Mohan

Chellappan³

et al. 2012

Journal of Ethnopharmacology

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Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration

Cited by 24 publications

References 19 publications

Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study

Posttraumatic levels of liver enzymes can reduce the need for CT in children: a retrospective cohort study

Toxicity assessment due to sub-chronic exposure to individual and mixtures of four toxic heavy metals

Hibiscus vitifolius (Linn.) root extracts shows potent protective action against anti-tubercular drug induced hepatotoxicity

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