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

Abstract

OBJECTIVE:

Current APSA recommendations for blunt spleen/liver injury (BSLI) entail bedrest equal to grade of injury plus one. We reported our experience 3 years ago with a prospectively implemented abbreviated protocol, one concern of which was that more numbers would be needed to support the safety of such a protocol. We are now reporting the final experience with this protocol as we move forward with further investigation.

METHODS:

Following IRB approval, data were collected prospectively in all patients with BSLI up to 8 weeks after discharge. There were no exclusion criteria, and patient accrual was consecutive. Bedrest was restricted to one night for Grade I & II injuries and two nights for Grade ≥ III.

RESULTS:

Between 11/2006 and 10/2012, 249 patients were admitted with BSLI. Mean age and weight were 10.3±4.8 years and 40.1±19.8 kg, respectively. Injuries included isolated spleen in 130 (52%), liver only in 107 (43%), and both in 12 (5%). One splenectomy was required for a grade V injury. Transfusions were used in 40 patients (16%), with 28 (11%) due to the injured solid organ. Bedrest for solid organ injury was applicable to 199 patients (80%), for which the mean grade of injury was 2.7±1.0 and mean bedrest was 1.6±0.6 days, resulting in 2.5±1.9 days of hospitalization. The need for bedrest was the limiting factor for length of stay in 155 patients (62%), for which mean grade of injury was 2.5±1.0 and mean bedrest was 1.6±0.6 days, resulting in 1.7±0.8 days of hospitalization. There were 4 deaths, 3 from brain injury and 1 from grade V liver injury. There were no patients readmitted for complications of solid organ injury.

CONCLUSIONS:

These data further validate that an abbreviated protocol of one night of bedrest for grade I and II injuries and two nights for grade ≥ III can be safely employed, resulting in dramatic decreases in hospitalization compared to the current APSA recommendations.

• Authors: Shawn D St Peter, Pablo Aguayo, David Juang, Susan W Sharp, Charles L Snyder, George W Holcomb 3rd, Daniel J Ostlie
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 48 Issue 12 Pg. 2437-41 (Dec 2013) ISSN: 1531-5037 [Electronic] United States
• PMID: 24314183 (Publication Type: Clinical Trial, Journal Article)
• Copyright: © 2013.

Topics

• Adolescent
• Bed Rest
• Child
• Female
• Follow-Up Studies
• Humans
• Injury Severity Score
• Length of Stay
• Liver (injuries)
• Male
• Prospective Studies
• Spleen (injuries)
• Treatment Outcome
• Wounds, Nonpenetrating (therapy)