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01.06.2014 | Original Article | Ausgabe 3/2014

European Journal of Trauma and Emergency Surgery 3/2014

Serum lipase for assessment of pancreatic trauma

Zeitschrift:
European Journal of Trauma and Emergency Surgery > Ausgabe 3/2014
Autoren:
B. Mitra, M. Fitzgerald, M. Raoofi, G. A. Tan, J. C. Spencer, C. Atkin

Abstract

Purpose

Pancreatic enzymes are routinely measured during reception of trauma patients to assess for pancreatic injury despite conflicting evidence on their utility. The aim of this study was to investigate the utility of routine initial serum lipase measurement for the diagnosis of acute pancreatic trauma.

Materials and methods

Lipase measurements were introduced as part of the trauma pathology panel and requested on all patients who presented to an adult major trauma service and met trauma call-out criteria. Clinical records of these patients were extracted from the trauma registry and retrospectively reviewed. The performance of an initial serum lipase level measured on presentation to detect pancreatic trauma was determined.

Results

There were 2,580 patients included in the study, with 17 patients diagnosed with pancreatic trauma. An elevated lipase was recorded in 390 patients. Statistically significant associations were observed for elevated lipase in patients with pancreatic trauma, head injury, acute alcohol ingestion and massive blood transfusion. As a test for pancreatic trauma, an abnormal serum lipase result had a specificity of 85.3 % (95 % CI 83.8–86.6), sensitivity of 76.5 % (95 % CI 49.8–92.2), positive predictive value of 3.3 % (95 % CI 1.8–5.8) and negative predictive value of 99.8 % (95 % CI 99.4–99.9). Higher cut-offs of serum lipase did not result in better performance.

Conclusions

A normal serum lipase result can be a useful adjunct to exclude pancreatic injury. A positive lipase result, regardless of the cut-off used, was not reliably associated with pancreatic trauma, and should not be used to guide further assessment.

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