Utility of Serum Amylase in Children With Abdominal Pain in the Pediatric Emergency Department

Abstract

Objectives: Abdominal pain is among the most common chief complaints seen in pediatric emergency departments (PEDs). This study aims to evaluate the diagnostic utility of amylase and lipase in the evaluation of abdominal pain in the PED.

Methods: Retrospective, cross-sectional study of patients aged 0 to 18 years with amylase and/or lipase while in the PED in 2019. Diagnostic utility of amylase and lipase was analyzed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio (LR). The χ 2 or Fisher exact test was used when appropriate.

Results: We identified 496 PED visits with tests for amylase (0.2%), lipase (53%), or both (46.8%). Abnormal levels for amylase and lipase were 4.6% and 5.6%, respectively. Amylase use in abdominal pain evaluation showed sensitivity of 30%, specificity of 92%, PPV of 26%, NPV of 93%, and LR of 7.1 ( P = 0.008). Lipase use in abdominal pain evaluation showed sensitivity of 7.5%, specificity of 94.5%, PPV of 10.7%, NPV of 92%, and LR of 0.251 ( P = 0.616). Amylase at 3 times its normal level showed sensitivity of 10%, specificity of 99.5%, PPV of 66.7%, NPV of 92.2%, and LR of 6.35 ( P = 0.012), whereas lipase showed a sensitivity of 5%, specificity of 99.3%, PPV of 40%, NPV of 92.2%, and LR of 3.9 ( P = 0.048). Identification of a clinically significant diagnosis via coordering of amylase and lipase versus lipase alone was not significant.

Conclusions: Although serum amylase and lipase testing may be suitable for abdominal pain screening, the concurrent use of both does not seem to add any clinically significant value to diagnosis.