Faculty Collaboration Database

National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Pediatr Surg 2014 Jun;49(6):1004-8; discussion 1008

Date

06/04/2014

Pubmed ID

24888852

DOI

10.1016/j.jpedsurg.2014.01.041

Scopus ID

2-s2.0-84901810961 (requires institutional sign-in at Scopus site)   49 Citations

Abstract

PURPOSE: Recent reports suggest that an abbreviated bed rest protocol (ABRP) may safely reduce length of stay (LOS) and resource utilization in pediatric blunt spleen and liver injury (BSLI) patients. This study evaluates national temporal trends in BLSI management and estimates national reduction in LOS using an ABRP.

METHODS: Pediatric patients (<18 years old) sustaining BLSI were identified in the Kids' Inpatient Database from 2000 to 2009. Yearly rates of injury and operative intervention were examined and stratified by type of injury. APSA guidelines and the reported ABRP were applied based on abbreviated injury score (AIS) and compared with actual LOS.

RESULTS: 22,153 patients were identified. Over the study period, operative rates for spleen and liver injuries and overall mortality significantly declined: LOS=3.1 days (±1.6) and 2.7 days (±1.9) for spleen and liver, respectively. If APSA guidelines were followed, the rates were LOS=3.7 days (±1.1) and 3.4 days (±0.7), respectively. Application of the ABRP would result in LOS=1.3 days (±0.5) for all BSLI patients. An ABRP could potentially save 1.7 hospital days/patient or 36,964 patient hospital days nationally.

CONCLUSION: Our study confirms a significant national decrease in operative intervention and overall mortality in patients with BSLI. Additionally, it appears that a shorter observation period than the APSA guidelines is being utilized. The implementation of ABRP holds potential in further reducing LOS and resource utilization.

Author List

Dodgion CM, Gosain A, Rogers A, St Peter SD, Nichol PF, Ostlie DJ

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abdominal Injuries
Child
Disease Management
Female
Humans
Incidence
Injury Severity Score
Length of Stay
Liver
Male
Spleen
Surgical Procedures, Operative
United States
Wounds, Nonpenetrating