Coant P N, Kornberg A E, Brody A S, Edwards-Holmes K
Department of Pediatrics (Emergency Medicine), Children's Hospital of Buffalo, NY 14222.
Pediatrics. 1992 Feb;89(2):274-8.
Children suffering physical abuse are at risk for abdominal trauma. When the abdominal trauma is not evident clinically and remains occult, the child's condition can rapidly deteriorate before the diagnosis is made, and delay may occur in the activation of child protective services. The use of markers for abdominal trauma in the evaluation of cases of child physical abuse was examined. Children younger than 12 years presenting to the Emergency Department at the Children's Hospital of Buffalo from August 1989 through April 1990 for the evaluation of suspected physical abuse were prospectively entered in the project. All patients had a complete history and physical examination performed. Those patients who did not show any signs of abdominal injury had the following laboratory tests done: (1) levels of liver transaminases, lactate dehydrogenase, and alkaline phosphatase; (2) amylase level; and (3) uranlysis. Of 49 patients without clinical signs of abdominal trauma, 4 children had elevated transaminase levels. Three of these 4 patients had liver lacerations documented by subsequent abdominal computed tomographic scans. A new finding of transaminase levels as markers of occult liver injury in children suffering physical abuse is reported.
遭受身体虐待的儿童有腹部创伤的风险。当腹部创伤在临床上不明显且仍为隐匿性时，在做出诊断之前，儿童的病情可能会迅速恶化，并且在启动儿童保护服务方面可能会出现延迟。对在儿童身体虐待病例评估中使用腹部创伤标志物进行了研究。1989年8月至1990年4月期间，前往布法罗儿童医院急诊科接受疑似身体虐待评估的12岁以下儿童被前瞻性纳入该项目。所有患者均进行了完整的病史和体格检查。那些没有显示出任何腹部损伤迹象的患者进行了以下实验室检查：（1）肝转氨酶、乳酸脱氢酶和碱性磷酸酶水平；（2）淀粉酶水平；（3）尿液分析。在49例无腹部创伤临床体征的患者中，4名儿童转氨酶水平升高。这4名患者中有3名随后的腹部计算机断层扫描证实有肝裂伤。报告了转氨酶水平作为遭受身体虐待儿童隐匿性肝损伤标志物的新发现。
