NCJ Number
224882
Journal
Child Abuse and Neglect Volume: 32 Issue: 9 Dated: September 2008 Pages: 838-845
Date Published
September 2008
Length
8 pages
Annotation
This study described the temporal pattern of serum hepatic transaminase concentrations in pediatric blunt liver trauma for estimating time of injury.
Abstract
Results confirm that after uncomplicated liver injury, data show that serum hepatic transaminase concentrations rise within hours, decline rapidly, and then normalize over days. An alanine aminotransferase (ALT) concentration greater than the aspartate aminotransferase (AST) concentration is specific but not sensitive for injury more than 12 hours old. Because the two transaminases had different rates of decline, their relative concentrations could permit verification of the time of injury, at least with regard to being within the first 12 hours after injury or more than 36 hours after injury. The findings of differential decay rates or the more rapid normalization of AST than ALT may be useful to confirm or cast doubt on a specific caregiver history, but the logarithmic nomogram would be inappropriate to apply before validation. Data such as these may be useful in cases where children with concerning injuries are presented for care with a history of a minimal or accidental mechanism for their injuries. While these data would not be useful in identifying a perpetrator in the case of a child with a large liver laceration and a history of an acute short fall, they could be additional data to suggest that the given history is unlikely. Data were collected in a retrospective review of pediatric patients with injuries including blunt liver trauma admitted to one of four urban level 1 trauma centers from 1990 to 2000. Cases were excluded for shock, death within 48 hours, complications, or inability to determine injury time. Transaminase concentration decline was modeled by individual patients, by injury grade, and as a ratio with regard to injury times. Tables, figures, and references