SERUM AMYLASE LEVEL ON ADMISSION IN THE DIAGNOSIS OF BLUNT INJURY TO THE PANCREAS - ITS SIGNIFICANCE AND LIMITATIONS

Objective The objective of this study was to elucidate the significanc e and limitations of serum amylase levels in the diagnosis of blunt in jury to the pancreas. Summary Background Data Several recently publish ed reports of analyses of patients with blunt abdominal trauma have in dicated that determination of the serum amylase level on admission see med to be of little value in the diagnosis of acute injury to the panc reas. Few previous reports have described clearly the significance and the limitations of the serum amylase level in diagnosing injury to th e pancreas. Methods Retrospective analysis of 73 patients with blunt i njury to the pancreas during 16-year period from February 1980 to Janu ary 1996 was performed. The factors analyzed in the current study incl uded age, gender, time elapsed from injury to admission, hypotension o n admission, type of injury to the pancreas, intra-abdominal- and intr acranial-associated injuries, and death. Results The serum amylase lev el was found to be abnormal in ail patients admitted more than 3 hours after trauma. Various comparisons between patients with elevated (n = 61, 83.6%) and nonelevated (n = 12, 16.4%) serum amylase levels showe d the statistical significance solely of the time elapsed from injury to admission (7 +/- 1.5 hours vs. 1.3 +/- 0.2 hour, p < 0.001). The ma jor factor that influences the serum amylase level on admission appear ed to be the time lapsed from injury to admission. Determination of th e serum amylase level is not diagnostic within 3 hours or fewer after trauma, irrespective of the type of injury.Conclusions To avoid failur e in the detection of pancreatic injury, the authors advocate determin ation of serum amylase levels more than 3 hours after trauma.