Journal article
Prospective results of a standardized algorithm based on hemodynamic status for managing pediatric solid organ injury
Journal of the American College of Surgeons, v 193(4), pp 347-353
01 Oct 2001
PMID: 11584961
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND:
Controversy surrounds the need for ICU admission, prolonged bed rest, and the duration of activity restrictions for children sustaining blunt trauma. Adult literature supports management based on hemodynamic status, not CT grade.
STUDY DESIGN:
A 3-year prospective study of a standardized management algorithm for hemodynamically normal pediatric patients with blunt liver or spleen injury was performed. Patient selection was based on vital signs, irrespective of injury grade on CT. Patients requiring ICU admission for nonliver or nonspleen injury were excluded. Patients were admitted to a surgical ward with serial hematocrit levels. Discharge occurred 48 hours postinjury if patients had no abdominal tenderness, tolerated a regular diet, and had a stable hematocrit. Patients were allowed noncontact activity, including school, after discharge. Patients were followed up at 1 month with ultrasonographic imaging.
RESULTS:
Eighty-nine patients sustained blunt liver or spleen injury. Forty-five patients were excluded for other injuries (Glasgow Coma Scale < 13, 32 of 45); the remaining 44 patients had a mean age of 8.9 years (range 2 to 17 years), Injury Severity Score 10.6 (range 4 to 33), liver grade 2.1, and splenic injury grade 2.3. Mechanisms of injury were predominately motor vehicle collisions (59%). All patients were managed nonoperatively without transfusion; 43 of 44 patients completed the algorithm. Mean observation was 55.2 ± 12.3 hours. One-month followup occurred in 33 of 44 patients, with one complication detected and no delayed bleeding.
CONCLUSIONS:
Management of pediatric solid organ injury should be guided by hemodynamic status and not injury grade on CT. Hemodynamically normal children can be safely managed without intensive care monitoring, do not need prolonged hospitalization, and can resume school on discharge.
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Details
- Title
- Prospective results of a standardized algorithm based on hemodynamic status for managing pediatric solid organ injury
- Creators
- John R Mehall - Arkansas Children's HospitalJared S Ennis - Arkansas Children's HospitalDaniel A Saltzman - Arkansas Children's HospitalJohn C Chandler - Arkansas Children's HospitalHarsh Grewal - Arkansas Children's HospitalCharles W Wagner - Arkansas Children's HospitalRichard J Jackson - Arkansas Children's HospitalSamuel D Smith - Arkansas Children's Hospital
- Publication Details
- Journal of the American College of Surgeons, v 193(4), pp 347-353
- Publisher
- Elsevier
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics; Surgery
- Web of Science ID
- WOS:000171141800001
- Scopus ID
- 2-s2.0-0034819939
- Other Identifier
- 991021931098304721
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- Web of Science research areas
- Surgery