Micah G Katz1, Zachary J Kastenberg2, Mark A Taylor3, Carol D Bolinger4, Eric R Scaife5, Stephen J Fenton6, Katie W Russell7. 1. Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132. Electronic address: Micah.Katz@hsc.utah.edu. 2. Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113. Electronic address: Zachary.Kastenberg@hsc.utah.edu. 3. Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132. Electronic address: Mark.Taylor@hsc.utah.edu. 4. Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113. Electronic address: Carol.Bolinger@imail.org. 5. Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113. Electronic address: Eric.Scaife@hsc.utah.edu. 6. Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113. Electronic address: Stephen.Fenton@hsc.utah.edu. 7. Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113. Electronic address: Katie.Russell@hsc.utah.edu.
Abstract
BACKGROUND/ PURPOSE: Nonoperative management of blunt solid organ injuries continues to progress and improve cost-effective utilization of resources while maximizing patient safety. The purpose of this study is to compare resource utilization and patient outcomes after changing admission criteria from a grade-based protocol to one based on hemodynamic stability. METHODS: A retrospective review of isolated liver and spleen injuries was done using prospectively collected trauma registry data from 2013 to 2017. The 2 years preceding the change were compared to the 2 years after protocol change. All analyses were performed using SAS 9.4. RESULTS: There were 121 patients in the preprotocol cohort and 125 patients in the postprotocol cohort. Baseline demographics were similar along with injury mechanisms and severity. The ICU admission rate decreased from 40% to 22% (p = 0.002). There were no adverse events on the floor and no patient needed to be transferred to the ICU. CONCLUSIONS: A protocol for ICU admission based on physiologic derangement versus solely on radiologic grade significantly reduced admission rates to the ICU in children with solid organ injury. The protocol was safe and effectively reduced resource utilization. LEVEL OF EVIDENCE: Level II, prospective comparison study.
BACKGROUND/ PURPOSE: Nonoperative management of blunt solid organ injuries continues to progress and improve cost-effective utilization of resources while maximizing patient safety. The purpose of this study is to compare resource utilization and patient outcomes after changing admission criteria from a grade-based protocol to one based on hemodynamic stability. METHODS: A retrospective review of isolated liver and spleen injuries was done using prospectively collected trauma registry data from 2013 to 2017. The 2 years preceding the change were compared to the 2 years after protocol change. All analyses were performed using SAS 9.4. RESULTS: There were 121 patients in the preprotocol cohort and 125 patients in the postprotocol cohort. Baseline demographics were similar along with injury mechanisms and severity. The ICU admission rate decreased from 40% to 22% (p = 0.002). There were no adverse events on the floor and no patient needed to be transferred to the ICU. CONCLUSIONS: A protocol for ICU admission based on physiologic derangement versus solely on radiologic grade significantly reduced admission rates to the ICU in children with solid organ injury. The protocol was safe and effectively reduced resource utilization. LEVEL OF EVIDENCE: Level II, prospective comparison study.