Safe phlebotomy reduction in stable pediatric liver and spleen injuries

Management of Pediatric Solid Organ Injuries

“…When 120 patients with BLSI were retrospectively analyzed to see how the proposed pathway would perform, they found that the new pathway would decrease blood draws by 70%, ICU admission by 65%, and hospital LOS by 37% [ 62 ]. A subsequent prospective study implementing a similar protocol found that most patients included were safely managed with a single blood draw, though more severely injured patients and those with active contrast extravasation on imaging were notably excluded from this analysis [ 63 ]. Patients in both studies who did require transfusion also demonstrated hemodynamic instability that would have otherwise removed them from the proposed pathway and therefore prevented a potential missed diagnosis that may be detected when following serial hemoglobin levels [ 62 , 63 ].…”

“…A subsequent prospective study implementing a similar protocol found that most patients included were safely managed with a single blood draw, though more severely injured patients and those with active contrast extravasation on imaging were notably excluded from this analysis [ 63 ]. Patients in both studies who did require transfusion also demonstrated hemodynamic instability that would have otherwise removed them from the proposed pathway and therefore prevented a potential missed diagnosis that may be detected when following serial hemoglobin levels [ 62 , 63 ]. In a separate retrospective study, Acker et al found that patients with BLSI who require surgical intervention or transfusion for ongoing bleeding do so within the first 24 h of presentation, suggesting that prolonged hemoglobin monitoring is likely to provide little clinical benefit [ 64 ].…”