Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study

Cunningham, Aaron J.; Lofberg, Katrine; Krishnaswami, Sanjay; Butler, Marilyn; Azarow, Kenneth S.; Hamilton, Nicholas A.; Fialkowski, Elizabeth; Bilyeu, Pamela; Ohm, Erika T.; Burns, Erin; Hendrickson, Margo; Krishnan, Preetha; Gingalewski, Cynthia; Jafri, Mubeen

doi:10.1016/j.jpedsurg.2017.08.035

Cited by 16 publications

(4 citation statements)

References 26 publications

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“…They noted a decrease in hospital LOS, ICU LOC, number of blood draws, and decreased in direct hospital costs ($11, 965 vs $8795) in their protocol group. 15 Our demographic data is similar to those in the existing literature. Our mean LOS of 2.85 ± 3.32 days was similarly lower than predicted per the 2000 APSA guidelines, which is consistent with the findings of our predecessors.…”

Section: Discussionsupporting

confidence: 77%

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Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury

Griffin

Richardson

Brierley

et al. 2023

The American Surgeon™

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Background In 2000, the American Pediatric Surgical Association (APSA) published guidelines for the management of pediatric solid organ injury, recommending a hospital length of stay (LOS) of grade of injury plus 1 day. Since the publication of these guidelines, several studies have suggested that it is safe to discharge patients sooner based upon hemodynamic and clinical factors. The results of several of these studies have been confounded by the existence of other injuries. The aim of this study was to examine LOS and outcomes in children with strictly isolated solid organ injuries. Materials and Methods This is a 12-year retrospective review of pediatric patients with isolated trauma to the kidney, liver, or spleen to determine LOS. Patients were excluded for associated intracranial, neurologic, orthopedic, or pulmonary injuries which would impact length of stay. Documented hemodynamic parameters were reviewed as determinants of patient stability. Results A total of 156 patients were included in the study. The projected average LOS for all patients based on the 2000 APSA guidelines would have been 3.71 ± 0.98 days. The actual average LOS for all patients 2.85 ± 3.32 days. Need for operation, ICU stay, and transfusion all contributed to increased LOS. The number of episodes of abnormal vitals positively correlated with increased LOS. Discussion This study validates that management of isolated solid organ injuries based upon hemodynamic parameters and clinical status is safe and decreases hospital length of stay. Consistently normal vital signs indicate these children can be safely discharged sooner.

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Section: Discussionsupporting

confidence: 77%

“…They noted a decrease in hospital LOS, ICU LOC, number of blood draws, and decreased in direct hospital costs ($11,965 vs $8795) in their protocol group. 15…”

Section: Discussionmentioning

confidence: 99%

Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury

Griffin

Richardson

Brierley

et al. 2023

The American Surgeon™

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“…Liberalized PMGs emphasizing abbreviated bedrest protocols with early mobilization and even hospital discharge in less than 24 hours have been demonstrated to be safe without any associated increase in the rate of acute or delayed bleeding complications. 5,12,[29][30][31] Furthermore, the implementation of abbreviated PMGs has been associated with significant reduction in the utilization of hospital resources, with the resulting annual savings estimated to be as high as US $19 million. 11 The clear benefits of adopting modernized NOM practices and the low rate of hospital-based interventions in children with low-grade SOI have caused several groups to question the necessity of inpatient observation in this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The growing body of evidence supporting the low failure rate of NOM in patients with SOI has helped catalyze the modernization of historically conservative NOM practices. Liberalized PMGs emphasizing abbreviated bedrest protocols with early mobilization and even hospital discharge in less than 24 hours have been demonstrated to be safe without any associated increase in the rate of acute or delayed bleeding complications 5,12,29–31 . Furthermore, the implementation of abbreviated PMGs has been associated with significant reduction in the utilization of hospital resources, with the resulting annual savings estimated to be as high as US $19 million 11 …”

Section: Discussionmentioning

confidence: 99%

Hospital-based intervention is rarely needed for children with low-grade blunt abdominal solid organ injury: An analysis of the Trauma Quality Improvement Program registry

Williams

Jin

Plumblee

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs). METHODS:A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization. RESULTS:A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index. CONCLUSION:Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management.

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Blunt Abdominal Trauma in Children: Clinical Perspective

Makin

2020

Contrast-Enhanced Ultrasound in Pediatric Imaging

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Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study

Cited by 16 publications

References 26 publications

Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury

Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury

Hospital-based intervention is rarely needed for children with low-grade blunt abdominal solid organ injury: An analysis of the Trauma Quality Improvement Program registry

Blunt Abdominal Trauma in Children: Clinical Perspective

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