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The role of serological tests in identifying abusive abdominal injury

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

  • Four diagnostic test studies addressed the value of serological markers in identifying occult abdominal injury 1-4
  • The optimal study design would include all children undergoing a “gold standard” investigation such as an abdominal computerised tomography (CT) scan. Two studies did not do this, thus limiting the value of their findings 1,3, one did but only 19.4% underwent definitive testing 4
  • A prospective study of 49 children less than 12 years of age presenting with suspected physical abuse underwent testing with liver transaminases, lactate dehydrogenase (LDH), alkaline phosphatase and amylase. 4 / 49 had elevated transaminases / LDH, three of whom had liver laceration. No child with negative serology underwent imaging 1
  • A prospective multi-centre study of 1,676 children with suspected abuse aged less than five years screening with transaminases. Not all children presenting underwent serology, and it is not clear how children were selected for testing. 259 children had elevated transaminases of whom 138 underwent “gold standard” testing. 41 / 138 had identifiable abdominal injury. A cut off of 80 IU/L was deemed “positive” and based on this the sensitivity of testing was 77% with a specificity of 82% 3
  • A retrospective review investigated 2,890 children aged less than ten years whose siblings were evaluated for abuse.
    • 53.2% underwent serological testing, although criteria for performing screening were not specified. 310 children had elevated transaminases of whom two thirds underwent definitive testing and 29.3% of whom had an intra-abdominal injury. It is of note that 13.7% of those with negative transaminases who underwent definitive testing also had an intra-abdominal injury
    • A secondary analysis of this data explored the level of positive serology in infants less than 6 months of age presenting with an isolated bruise. 92/146 (63%) underwent serology, of whom 14 had elevated enzymes, 12 of whom underwent CT. 4/15 children overall undergoing CT had a liver laceration or contusion, it is not clear whether these children had elevated enzymes or not 2

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References

  1. Coant PN, Kornberg AE, Brody AS, Edwards-Holmes K. Markers for occult liver injury in cases of physical abuse in children. Pediatrics. 1992;89(2):274-278 [Pubmed]
  2. Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM; Examining Siblings To Recognize Abuse Investigators. Additional injuries in young infants with concern for abuse and apparently isolated bruises. Journal of Pediatrics. 2014;165(2):383-388.e1. [Pubmed]

  3. Lindberg D, Makoroff K, Harper N, Laskey A, Bechtel K, Deye K, Shapiro R, for the ULTRA Investigators. Utility of hepatic transaminases to recognize abuse in children. Pediatrics. 2009;124(2):509-516 [Pubmed]
  4. Lindberg DM, Shapiro RA, Blood EA, Steiner RD, Berger RP. Utility of hepatic transaminases in children with concern for abuse. Pediatrics. 2013;131(2):268-275. [Pubmed]

  • A study of the value of CT imaging of 84 abused children aged less than five years of age compared positive CT imaging to positive serology 1
    • 56 children underwent serology 1
    • 21 / 27 children with abdominal injury had elevated transaminases while 19 / 29 with normal abdominal CT also had elevated serology 1
    •  Elevated amylase or lipase found in 14 /28 children with abdominal injury and 2 /14 with a normal CT 1

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References

  1. Hilmes MA, Hernanz-Schulman M, Greeley CS, Piercey LM., Yu C, Kan JH. CT identification of abdominal injuries in abused pre-school-age children. Pediatric Radiology. 2011;41(5):643-651 [Pubmed]

 

 

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