Follow up of prospective validation of an abbreviated bedrest protocol in the management of blunt spleen and liver injury in children

Twenty-years of splenic preservation at a level 1 pediatric trauma center

“…This CPG was modified to allow for earlier discharge in patients who were otherwise clinically ready and this resulted in a slight reduction in length of stay, despite an increase in the grade of splenic injury and the mean injury severity score. Other institutions have also reported protocols for the management of this condition with great success [15,16].…”

Pediatric blunt abdominal trauma

“…Beginning shortly after the APSA guidelines were published, management based on grade of injury was challenged [25,26]. In the landmark publication, 'Throwing out the ''grade'' book,' the authors from Arkansas showed that management based on hemodynamic status was safe in a small cohort of patients.…”

“…In the landmark publication, 'Throwing out the ''grade'' book,' the authors from Arkansas showed that management based on hemodynamic status was safe in a small cohort of patients. More than 600 children have been prospectively managed or had their retrospective courses validated as safe based on hemodynamics rather than organ injury grade [25][26][27][28]. …”

The effectiveness of non-operative treatment in high-grade liver and spleen injury

“…Also, in our study, the length of hospitalization, the duration of ICU stay and transfusion requirement were found to be significantly higher in patients with highgrade liver injury than those with low-grade liver injury. Despite St Peter SD et al [8,9] recommended abbreviated bed rest protocol regardless of grade, we think that the ICU followup is important on the first day to perform non-operative management effectively and to determine timing of surgical intervention correctly, particularly in patients with high-grade liver injury.…”

“…They observed that patients without clinical evidence of hemorrhage did not need surgery after two days of hospitalization. St Peter SD et al [8,9] presented two prospective studies to evaluate the reliability and efficacy of the protocol that they established by reducing the length of hospitalization. One night hospitalization in Grade I-II patients and two nights in higher grades were recommended.…”