David M Notrica1, Lois W Sayrs2, Nidhi Krishna2, Daniel J Ostlie3, Robert W Letton4, Adam C Alder5, Shawn D St Peter6, Todd A Ponsky7, James W Eubanks8, David W Tuggle9, Nilda M Garcia9, Charles M Leys10, R Todd Maxson11, Amina M Bhatia12. 1. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016. Electronic address: dnotrica@phoenixchildrens.com. 2. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016. 3. Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016; American Family Children's Hospital, 1675 Highland Ave, Madison, WI, USA 53792. 4. The Children's Hospital at OU Medical Center, 940 NE 13(th) St, #1b1306, Oklahoma City, OK, USA, 73104. 5. Children's Medical Center, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX, USA 75235. 6. Mercy Children's Hospital, 2401 Gilham Rd, Kansas City, MO, USA 64108. 7. Akron Children's Hospital, 1 Perkins Sq, Akron, OH, USA 44308. 8. Le Bonheur Children's Hospital, 50 N Dunlap St, Memphis, TN, USA 38103. 9. Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX, USA 78723. 10. American Family Children's Hospital, 1675 Highland Ave, Madison, WI, USA 53792. 11. Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, USA 72202. 12. Children's Healthcare of Atlanta, 1975 Century Blvd NE#6, Atlanta, GA, USA 30345.
Abstract
BACKGROUND: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury +2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. METHODS: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤18 years). RESULTS: Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). CONCLUSION: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. LEVEL OF EVIDENCE: Level II, Prognosis.
BACKGROUND: After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury +2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes. METHODS: Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤18 years). RESULTS: Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]). CONCLUSION: For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline. LEVEL OF EVIDENCE: Level II, Prognosis.
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165