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Value of focused assessment with sonography for trauma combined with hepatic transaminase in diagnosis of blunt abdominal trauma in children
- TONG Haiting, PAN Shuming, DU Qirong, et al
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Journal of Clinical Pediatrics. 2019, 37(10):
761.
doi:10.3969/j.issn.1000-3606.2019.10.010
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Abstract
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Objective To explore the value of focused assessment with sonography for trauma (FAST) combined with aspartate aminotransferase (AST)/alanine aminotransferase (ALT) in diagnostic of blunt abdominal trauma (BAT) in children. Method The clinical data of emergency BAT in children from January 2015 to January 2018 were retrospectively analyzed. The children who performed the examinations of FAST, abdominal CT and serum AST/ALT simultaneously were selected as study subjects. Children with FAST positive and AST>200 IU/L and/or ALT>125 IU/L were selected as group A, while children with FAST positive and AST>400 IU/L and/or ALT>200 IU/L were selected as group B. Taking CT examination results as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the diagnosis of BAT in FAST group (group A and group B) were compared. Results A total of 1588 BAT children were included, and 209 of them completed FAST, CT and serum AST/ALT examinations. Among the 209 children, 51 (24.4%) were positive in CT examination. Taking CT examination results as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BAT diagnosis were 51.0%, 94.9%, 76.5%, 85.7% and 84.2% respectively when using FAST. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BAT diagnosis were 88.2%, 93.7%, 81.8%, 96.1% and 92.3% respectively in group A. The sensitivity, negative predictive value and accuracy of group A were higher than those of FAST, and the differences were statistically significant (P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BAT diagnosis were 58.8%, 93.7%, 75.0%, 87.6% and 85.2%, respectively in group B and there was no difference between group B and FAST (P > 0.05). Nine of the 10 children with surgery were FAST positive or serum AST > 400 IU/L or ALT > 200 IU/L. Conclusion FAST combined with serum AST>200 IU/L and/or ALT>125 IU/L can be used as an effective screening tool for diagnosis of BAT in children. For children with FAST positive but serum AST>400 IU/L or ALT>200 IU/L, CT examination is recommended for those with hemodynamic stability, which can not only ensure the safety of children, but also reduce unnecessary CT radiation damage.
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