CAPS papers
Utility of amylase and lipase as predictors of grade of injury or outcomes in pediatric patients with pancreatic trauma

https://doi.org/10.1016/j.jpedsurg.2011.02.033Get rights and content

Abstract

Introduction

Grade of injury, serum amylase, and lipase are markers used to assess pancreatic injury. It is unclear how amylase and lipase relate to grade of injury or predict outcome. We hypothesize that serum amylase and lipase are good predictors of grade of injury and outcomes in patients with pancreatic trauma.

Methods

This study is a multicenter review from 9 pediatric trauma centers of all children admitted to their institution over 5 years with a pancreatic injury. Initial as well as peak amylase and lipase values were analyzed with relation to pancreatic grade, length of stay, and outcomes.

Results

One hundred thirty-one records were analyzed. There were 44 girls and 85 boys with an average age of 9.0 ± 0.4 years. The mean injury severity score (ISS) score was 15.5 ± 1.2 SE. The average length of stay (in days) was analyzed by grades 0 (3.93), 1 (7.73), 2 (13.4), 3 (18.4), 4 (31), and 5 (13.5). Neither initial nor peak amylase/lipase correlated with grade of injury. Neither amylase nor lipase predicted length of stay or mortality. Maximal amylase was highly predictive of developing a pseudocyst.

Conclusion

There seems to be limited value for repetitive routine amylase and lipase levels in the management of pediatric trauma patients with pancreatic injury.

Section snippets

Methods

This was a multicenter retrospective review from 9 pediatric trauma centers (see participating centers in acknowledgements). All contributing centers are members of the American Pediatric Surgery Association Trauma Committee. Institutional review board approval was obtained at each center. Each institution collected data on children (<18 years old) with a documented pancreatic injury. A common data collection form was used, and 5 years of data was collected (2003-2008). The data were then sent

Results

The study took place between 2003 and 2008. One hundred thirty-one cases were submitted. There were 85 boys, 44 girls, and 2 cases where the gender was not recorded. The average age was 9.0 ± 0.4 years (mean ± SD). The mean ± SD ISS score was 15.5 ± 1.2. There were 12 deaths. Motor vehicle collisions and bicycle crashes were the most common injury mechanisms. For this study, 111 cases had complete data for amylase, and 91 had complete data for the lipase evaluation. The total number of patients

Discussion

In December 2008, the World Health Organization released the “World Report on Child Injury Prevention” that established injury as the number 1 pediatric public health problem in the world [16]. Despite this report, national authorities have identified not only critical deficiencies in pediatric trauma care but also insufficient research to address these deficiencies. One factor that contributes to this problem is the limited number seriously injured children treated at a single center [17].

Acknowledgments

The authors thank the members of the American Pediatric Surgical Association Committee on Trauma Participating Institutions and Surgical Leads: David P. Mooney, MD (Boston Children's Hospital, Boston, MA); Randall Burd, MD (Childrens National Medical Center, Washington, DC); Robert Letton, MD (Oklahoma Children's Hospital, Oklahoma City, OK); Katheryn Bass, MD (Cook Children's Hospital, Chicago, IL); Mindy Statter, MD (Comer Children's Hospital at the University of Chicago, Chicago, IL);

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