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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References
Namias N, McKenney MG, Martin LC. Utility of admission chemistry and coagulation profiles in trauma patients: a reappraisal of traditional practice. J Trauma. 1996;41(1):21–5.
Tasse JL, Janzen ML, Ahmed NA, Chung RS. Screening laboratory and radiology panels for trauma patients have low utility and are not cost effective. J Trauma. 2008;65(5):1114–6. doi:10.1097/TA.0b013e318184b4f2.
Tortella BJ, Lavery RF, Rekant M. Utility of routine admission serum chemistry panels in adult trauma patients. Acad Emerg Med. 1995;2(3):190–4.
Chu UB, Clevenger FW, Imami ER, Lampard SD, Frykberg ER, Tepas JJ 3rd. The impact of selective laboratory evaluation on utilization of laboratory resources and patient care in a level-I trauma center. Am J Surg. 1996;172(5):558–62. doi:10.1016/s0002-9610(96)00234-6 (discussion 62-3).
Adamson WT, Hebra A, Thomas PB, Wagstaff P, Tagge EP, Othersen HB. Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma. J Pediatr Surg. 2003;38(3):354–7. doi:10.1053/jpsu.2003.50107 (discussion-7).
Herman R, Guire KE, Burd RS, Mooney DP, Ehlrich PF. Utility of amylase and lipase as predictors of grade of injury or outcomes in pediatric patients with pancreatic trauma. J Pediatr Surg. 2011;46(5):923–6. doi:10.1016/j.jpedsurg.2011.02.033.
Matsuno WC, Huang CJ, Garcia NM, Roy LC, Davis J. Amylase and lipase measurements in paediatric patients with traumatic pancreatic injuries. Injury. 2009;40(1):66–71. doi:10.1016/j.injury.2008.10.003.
Mayer JM, Tomczak R, Rau B, Gebhard F, Beger HG. Pancreatic injury in severe trauma: early diagnosis and therapy improve the outcome. Dig Surg. 2002;19(4):291–7. doi:http://www.ncbi.nlm.nih.gov/pubmed/12207073 (discussion 7-9).
Kumar S, Sagar S, Subramanian A, Albert V, Pandey RM, Kapoor N. Evaluation of amylase and lipase levels in blunt trauma abdomen patients. J Emerg Trauma Shock. 2012;5(2):135–42. doi:10.4103/0974-2700.96482.
Buechter KJ, Arnold M, Steele B, Martin L, Byers P, Gomez G, et al. The use of serum amylase and lipase in evaluating and managing blunt abdominal trauma. Am Surg. 1990;56(4):204–8.
Boulanger BR, Milzman DP, Rosati C, Rodriguez A. The clinical significance of acute hyperamylasemia after blunt trauma. Can J Surg. 1993;36(1):63–9.
Farkouh E, Wassef R, Atlas H, Allard M. Importance of the serum amylase level in patients with blunt abdominal trauma. Can J Surg. 1982;25(6):626–8.
Olsen WR. The serum amylase in blunt abdominal trauma. J Trauma. 1973;13(3):200–4.
Tourtier JP, Jost D, Domanski L. Shock index: a simple clinical parameter for mortality risk assessment in trauma? J Trauma Acute Care Surg. 2012;73(3):780–1. doi:10.1097/TA.0b013e31825ff540 (author reply 1).
Mitra B, Cameron PA, Gruen RL, Mori A, Fitzgerald M, Street A. The definition of massive transfusion in trauma: a critical variable in examining evidence for resuscitation. Eur J Emerg Med. 2011;18(3):137–42. doi:10.1097/MEJ.0b013e328342310e.
Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Shackford SR, Champion HR, et al. Organ injury scaling. Surg Clin North Am. 1995;75(2):293–303.
Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL. Management of blunt major pancreatic injury. J Trauma. 2004;56(4):774–8.
Pezzilli R, Billi P, Barakat B, Fiocchi M, Re G, Gullo L, et al. Serum pancreatic enzymes in patients with coma due to head injury or acute stroke. Int J Clin Lab Res. 1997;27(4):244–6.
Justice AD, DiBenedetto RJ, Stanford E. Significance of elevated pancreatic enzymes in intracranial bleeding. South Med J. 1994;87(9):889–93.
Vitale GC, Larson GM, Davidson PR, Bouwman DL, Weaver DW. Analysis of hyperamylasemia in patients with severe head injury. J Surg Res. 1987;43(3):226–33.
Bouwman DL, Altshuler J, Weaver DW. Hyperamylasemia: a result of intracranial bleeding. Surgery. 1983;94(2):318–23.
Malinoski DJ, Hadjizacharia P, Salim A, Kim H, Dolich MO, Cinat M, et al. Elevated serum pancreatic enzyme levels after hemorrhagic shock predict organ failure and death. J Trauma. 2009;67(3):445–9. doi:10.1097/TA.0b013e3181b5dc11.
Degiannis E, Glapa M, Loukogeorgakis SP, Smith MD. Management of pancreatic trauma. Injury. 2008;39(1):21–9. doi:10.1016/j.injury.2007.07.005.
Smith RC, Southwell-Keely J, Chesher D. Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis? ANZ J Surg. 2005;75(6):399–404. doi:10.1111/j.1445-2197.2005.03391.x.
Fleming WR, Collier NA, Banting SW. Pancreatic trauma: Universities of Melbourne HPB Group. Aust N Z J Surg. 1999;69(5):357–62.
Cox S, Currell A, Harriss L, Barger B, Cameron P, Smith K. Evaluation of the Victorian state adult pre-hospital trauma triage criteria. Injury. 2012;43(5):573–81. doi:10.1016/j.injury.2010.10.003.
Acknowledgments
We would like to thank staff at The Alfred Hospital Trauma Registry and in particular, Ms. Louise Niggemeyer for extraction of data.
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Mitra, B., Fitzgerald, M., Raoofi, M. et al. Serum lipase for assessment of pancreatic trauma. Eur J Trauma Emerg Surg 40, 309–313 (2014). https://doi.org/10.1007/s00068-013-0341-z
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DOI: https://doi.org/10.1007/s00068-013-0341-z