The predictive value of biochemical parameters in evaluating patients with abdominal trauma: The new scoring system
Ekrem Musalar1, Murat Ersel2, Funda Karbek Akarca2, Güçlü Selahattin Kıyan2<&sup>, Özge Can2
1Koc University Hospital, Emergency Department, Topkapı, İstanbul, Turkey
2Ege University School of Medicine, Emergency Department, Bornova İzmir, Turkey
Keywords: Multitrauma; Abdominal trauma; Biochemical parameters; AST; ALT; Lipase; Hemoglobin
Abstract
Aim: The aim of this study was to investigate the contribution of non-invasively and rapidly obtained biochemical parameter results to the diagnosis and follow-up of intraabdominal injuries in multitrauma patients.
Material and Methods: A total of 2604 multitrauma patients who were treated following their referral to our emergency department between January 2009 and January 2012 were retrospectively reviewed. A logistic regression analysis was used in the risk assessment.
Results: Statistically significant associations between intraabdominal injury and certain biochemical variables measured at the time of the referral were determined. These variables were hemoglobin ≤9.99 g/dL [odds ratio (OR): 6.25, 95% CI: 2.86–13.52, p < 0.0001], serum alanine amino transferase (ALT) ≥ 100 IU/L (OR: 34.45, 95% CI: 21.76–54.54, p < 0.0001), and serum lipase ≥ 61 U/L (OR: 10.44, 95% CI: 6.56–16.49, p < 0.0001). The pretest probability score was determined for each patient by adding the scores that were obtained from each factor. ROC curve analysis was performed to determine the diagnostic value of the pretest probability score for detecting intra-abdominal injury (area = 0.88; p < 0.0001).
Conclusion: The results of our study demonstrated that biochemical parameters may contribute to the diagnosis and follow-up of intraabdominal injuries in multitrauma patients. In particular, ALT, AST, CK and myoglobin were found to have higher ORs than low hemoglobin. After these parameters are tested in larger scale studies in conjunction with the gold standard multislice abdominal CT, they may be used for establishing scores to evaluate the severity of abdominal injuries.