Utility of screening urinalysis to detect abdominal injuries in suspected victims of child physical abuse.

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2020 Sep 24

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<p><strong>BACKGROUND: </strong>Urinalysis, liver enzymes (LE) and lipase are used to screen for abdominal injuries in children with suspected physical abuse (SPA). However, data on the utility of urinalysis is limited.</p>

<p><strong>OBJECTIVES: </strong>Describe the prevalence of hematuria in evaluations for SPA. Determine test characteristics of hematuria, LE and lipase to identify kidney and other abdominal injuries among children with SPA.</p>

<p><strong>PARTICIPANTS AND SETTING: </strong>Children &lt; 7 years receiving a urinalysis during evaluation for SPA by a hospital child protection team.</p>

<p><strong>METHODS: </strong>Demographic, clinical, and laboratory data including presence of hematuria (blood on urine dipstick), elevated LE (&gt; 80 U/L) and elevated lipase (&gt; 100 U/L) were abstracted retrospectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the overall study population and for patients without abdominal symptoms.</p>

<p><strong>RESULTS: </strong>Ten percent of patients had hematuria (N = 237). Prevalence of abdominal and kidney injuries was 7 % and 1 % respectively. Of 3 patients with kidney injury, 2 had hematuria and all had elevated LE. Sensitivity (67 %) and NPV (99 %) of hematuria to detect kidney injuries were lower than LE and the same as lipase. Specificity (91 %) and PPV (8%) of hematuria to detect kidney injury were greater than LE and similar to lipase. Sensitivity of hematuria to detect any abdominal injury (50 %) was lower than LE (81 %). Sensitivity of hematuria to detect occult abdominal injury was 0 %.</p>

<p><strong>CONCLUSIONS: </strong>Hematuria alone did not lead to detection of kidney injury. Test characteristics of hematuria were largely similar or inferior to LE and lipase.</p>






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