Authors
Lindberg, Daniel M.Makoroff, Kathi
Harper, Nancy
Laskey, Antoinette
Bechtel, Kirsten
Deye, Katherine
Shapiro, Robert
Using Liver Transaminases to Recognize Abuse (ULTRA) Study Investigators
UMass Chan Affiliations
Department of PediatricsDocument Type
Journal ArticlePublication Date
2009-08-01Keywords
Abdominal Injuries; Alanine Transaminase; Aspartate Aminotransferases; Child Abuse; Child, Preschool; Emergency Service, Hospital; Female; Humans; Infant; Infant, Newborn; Liver Function Tests; Magnetic Resonance Imaging; Male; Mass Screening; Physical Examination; Predictive Value of Tests; Prospective Studies; ROC Curve; Reference Values; Referral and Consultation; Tomography, X-Ray ComputedPediatrics
Metadata
Show full item recordAbstract
OBJECTIVE: Although experts recommend routine screening of hepatic transaminases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in cases of potential child physical abuse, this practice is highly variable. Our objective was to determine the sensitivity and specificity of routine transaminase testing in young children who underwent consultation for physical abuse. PATIENTS AND METHODS: This was a prospective, multicenter, observational study of all children younger than 60 months referred for subspecialty evaluation of possible physical abuse. The child abuse team at each center recommended screening transaminases routinely as standard of care for all cases with a reasonable concern for physical abuse. Sensitivity and specificity for transaminases and clinical examination findings to detect identified abdominal injuries were determined, and receiver operating characteristic analysis was undertaken. RESULTS: Of 1676 consultations, 1272 (76%) patients underwent transaminase testing, and 54 (3.2% [95% confidence interval: 2.4-4.2]) had identified abdominal injuries. Area under the curve for the highest level of either transaminase was 0.85. Using a threshold level of 80 IU/L for either AST or ALT yielded a sensitivity of 77% and a specificity of 82% (positive likelihood ratio: 4.3; negative likelihood ratio: 0.3). Of injuries with elevated transaminase levels, 14 (26%) were clinically occult, lacking abdominal bruising, tenderness, and distention. Several clinical findings used to predict abdominal injury had high specificity but low sensitivity. CONCLUSIONS: In the population of children with concern for physical abuse, abdominal injury is an important cause of morbidity and mortality, but it is not so common as to warrant universal imaging. Abdominal imaging should be considered for potentially abused children when either the AST or ALT level is >80 IU/L or with abdominal bruising, distention, or tenderness.Source
Pediatrics. 2009 Aug;124(2):509-16. Epub 2009 Jul 20. doi:10.1542/peds.2008-2348DOI
10.1542/peds.2008-2348Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43792PubMed ID
19620197Notes
Rebecca Moles and Carolyn Keiper of the University of Massachusetts Medical School are also ULTRA Investigators.
Related Resources
Link to article in PubMedae974a485f413a2113503eed53cd6c53
10.1542/peds.2008-2348