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In a multicenter retrospective analysis of children <10 years of age evaluated for suspected physical abuse, investigators assessed the test characteristics of elevated hepatic transaminases — alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >80 IU/L — for identifying occult intra-abdominal injuries.
Of 2890 children from 20 participating centers, 82 had at least one occult intra-abdominal injury. Of these, likelihood for physical abuse was categorized as definitive in 61, substantial in 11, and very concerning in 6; only 4 patients had intermediate or lower likelihood of abuse.
Of 1538 children (53%) who underwent transaminase testing, 298 (19%) had definitive testing (e.g., computed tomography [CT], autopsy, laparotomy), …