Application of the APSA evidence-based guidelines for isolated liver or spleen injuries: a single institution experience

Pediatric Splenic Injury: Nonoperative Management First!

“…During the past couple of years, evidence-based guidelines were developed to serve as a framework for the nonoperative management of hemodynamically stable pediatric patients with isolated splenic injury [8][9][10]. However, there is still considerable variation in the management of pediatric splenic injuries, with significantly lower rates of splenectomy at designated children's hospitals [11].…”

Prophylactic embolization of hepatic artery pseudoaneurysm after blunt abdominal trauma in a child

“…Based on the American Pediatric Surgery Association) guidelines, hemodynamically stable children with blunt liver trauma are treated conservatively and discharged early from hospital [1,2]. However, some patients with hepatic injury develop associated posttraumatic hepatic artery pseudoaneurysms [3][4][5].…”

Benchmarks for splenectomy in pediatric trauma: How are we doing?

“…Though some of the disparity in operative rates can be alleviated by transfer of children to PTCs, transfer of all children with blunt splenic injuries is neither necessary nor feasible. Leinwand et al found that implementation of a practice management guideline based on APSA recommendations was effective in decreasing resource utilization in children with blunt splenic injuries [8]. The ACSCOT will soon require use of "clinical practice guidelines, protocols, and algorithms derived from evidenced-based validated resources" as part of the verification process for situations including massive transfusion, cervical spine clearance, and venous thromboembolism prophylaxis [16].…”

“…Guidelines for nonoperative management were created based on review of 856 children treated at PTC and subsequently validated as effective in reducing resource utilization and improving outcomes [6][7][8]. Intensive care unit (ICU) admission was recommended only for children with grade IV injuries.…”