Blood Utilization in Children Managed Non-Operatively for Blunt Solid Organ Injury

Keckler, Scott J.; Tsao, KuoJen; Sharp, Susan W.; Holcomb, George; Ostle, Daniel J.; Peter, Shawn D. St.

doi:10.1016/j.jss.2008.03.027

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…13 More importantly, we were able to achieve these results while maintaining the use of PRBC transfusion at or below national averages, which range from 9.5 to 25 per cent. 4,11,28,29 For isolated splenic injuries, our PRBC transfusion rate was 5.6 per cent. Finally, during the time period studied, there was only one in 180 angioembolizations performed at our institution.…”

Section: Discussionmentioning

confidence: 90%

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Day

Steigman

Aidlen

et al. 2014

The American Surgeon™

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Nonoperative management of hemodynamically stable blunt splenic injury (BSI) is the gold standard in children. Recent studies from nonpediatric surgery-specialized trauma centers have demonstrated a rise in transfusion and angioembolization associated with decreased splenectomy rates. We investigate the rate of splenectomy and nonsurgical interventions (angioembolization, blood transfusion) for BSI in a pediatric surgery-specialized trauma center. We conducted a retrospective review of children (0 to 18 years) treated between September 2001 and September 2011 at a children's hospital. Analyzed data included presenting vital signs, nadir hemoglobin, splenic injury grade, Revised Trauma Score, and Injury Severity Score (ISS). Measured outcomes included transfusion, angioembolization, and splenectomy rates. The study period was divided into three time periods to identify possible trends and compared with national averages. There were 180 patients, 91 with multiple injuries (50.6%) and 89 (49.4%) with isolated BSI. Seventy-six per cent of patients were male, average age was 12.8 years, and average ISS was 14.7. The overall splenectomy rate was 1.7 per cent (1.1% for isolated splenic injury). Our angioembolization rate was 0.6 per cent compared with 7.4 to 16 per cent nationally. Our transfusion rate was 14.4 per cent overall and 5.6 per cent for isolated splenic injury compared with 9.5 to 24.9 per cent nationally. Intervention rates remained unchanged over the study period. Splenectomy rates have remained low at our institution without an increase in angioembolization or transfusion. Children with splenic injuries treated at dedicated pediatric hospitals can be successfully managed nonoperatively without angioembolization or blood transfusion.

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Section: Discussionmentioning

confidence: 90%

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Day

Steigman

Aidlen

et al. 2014

The American Surgeon™

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“…These factors may also be independent determinants of receiving a transfusion in the PICU, because supportive, nonsurgical care, including blood transfusion, is the standard of practice for hepatic, splenic, and renal injury in hemodynamically stable children . Indeed, conservative management has been suggested to reduce blood use in this population; however, before restrictive transfusion strategies are implemented, prospective studies in patients with trauma detailing types of injury and ongoing hemodynamic stability are needed.…”

Section: Discussionmentioning

confidence: 99%

Determinants of red blood cell transfusion in pediatric trauma patients admitted to the intensive care unit

et al. 2016

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Trauma patients are at high risk for receiving an RBC transfusion both before and during their PICU stay, despite a similar transfusion threshold compared with nontrauma patients. Transfusion before PICU admission is a strong determinant, suggesting ongoing bleeding that will require re-transfusion. Further studies are needed to evaluate whether a restrictive transfusion strategy can safely be considered in these patients.

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Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury

Welker

Novák

Jelsma

et al. 2018

Journal of Pediatric Surgery

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Blood Utilization in Children Managed Non-Operatively for Blunt Solid Organ Injury

Cited by 3 publications

References 12 publications

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

Determinants of red blood cell transfusion in pediatric trauma patients admitted to the intensive care unit

Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury

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