1089

Abstract

Staphylococcus and Streptococus the most common organisms. Two deaths were noted with average time to laparotomy 1h31m(+/-11m) (vs 20h17m+/-2h16m in survivors, p<0.05). Conclusions: Laparotomy after trauma is a rare event that requires significant critical resource utilization.Learning Objectives: The Pediatric Solid Organ Injury Pathway was instituted at Harborview Medical Center (HMC) in 2005 to improve fluid resuscitation efforts and standardize operative decision-making for patients admitted with isolated solid organ injury. We aimed to evaluate operative interventions in this population from 2001-2012, with the hypothesis that the institution of the pathway is associated with a decrease in abdominal operative interventions, including splenectomy, over time. Methods: Trauma patients under 18 years of age treated at HMC from 2001-2012 were identified in the Harborview Trauma Registry via ICD-9 codes for the presence of liver and spleen injuries. Demographic information, clinical characteristics and ICD-9 procedure codes were also obtained from the Trauma Registry. Results: The pediatric solid organ injury population at HMC (n=712) had a high frequency of high-grade injury (35% grade IV or V) and a high level of overall injury severity (mean Injury Severity Score (ISS) = 24). A minority of patients had isolated organ injury (32%) and were thus eligible for pathway care beginning in 2005. Among patients with isolated spleen or liver injury, 4.7% (adjusted for ISS quartile) underwent a related abdominal surgery (exploratory laparotomy, spleen or liver repair, or splenectomy) in 2001-2004, vs. 4.9% in 2005-2012. Among patients with isolated splenic injury, 5.7% (adjusted) received splenectomy in 2001-2004, compared to 3.7% in 2005-2012. Among patients with non-isolated splenic injury, who were not eligible for pathway care as written but for whom pathway care may have been utilized, 8.8% (adjusted) received splenectomy in 2001-2004, vs. 7.6% in 2005-2012. Conclusions: The pathway applies to a minority of solid organ injury patients due to the low proportion having isolated organ injury, indicating a potential opportunity to formally expand pathway care to other trauma populations at HMC. In both time periods, receipt of splenectomy was infrequent. Adjusting for ISS, slightly fewer splenectomies occurred in the post-pathway period compared to the pre-pathway period.