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Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma
1Babies and Children's Hospital, New York, NY 10032, USA.
Insights
Treatment guidelines for pediatric spleen and liver injuries were developed to standardize care and improve resource use. This consensus aims to enhance patient safety and optimize management for isolated injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Clinical Guidelines
Background:
- Disparities exist in managing pediatric isolated spleen or liver injuries.
- Current practices vary significantly across institutions.
- Need for consensus to ensure patient safety and efficient resource allocation.
Purpose of the Study:
- To resolve treatment disparities for pediatric isolated spleen and liver injuries.
- To reach a consensus on optimal management strategies.
- To determine current practices for resource utilization.
Main Methods:
- Analysis of 832 pediatric cases with isolated spleen/liver injury (CT grade I-IV).
- Data collected on ICU stay, hospital stay, transfusions, operations, imaging, and activity restrictions.
- Literature review and consensus conference by the APSA Trauma Committee.
Main Results:
- Resource utilization correlates with injury severity.
- Proposed evidence-based guidelines for resource use in routine cases.
- Recommendations align with established practices (within 25th percentile).
Conclusions:
- Confirmed diversity in treatment and resource utilization for similar injuries.
- Proposed guidelines aim to standardize patient management.
- Evidence-based approach enhances safety and optimizes resource use, prompting further validation studies.
Purpose:
This study is intended to resolve the disparity and reach consensus on issues regarding the treatment of children with isolated spleen or liver injuries. To maximize patient safety and assure efficient, cost-effective utilization of resources, it was essential to determine current practice.
Methods:
Data from the case records of 856 children with isolated spleen or liver injury treated at 32 pediatric surgical centers from July 1995 to June 1997 were collected. The severity of injury was classified by computed tomography (CT) grade and the data analyzed for intensive care unit (ICU) stay, length of hospital stay, transfusion requirement, need for operation, pre- and postdischarge imaging, and restriction of physical activity. Patients with grade V injuries (2.8%) were excluded leaving 832 patients for detailed review. These data and available literature were analyzed for consensus by the 1998 APSA Trauma Committee.
Results:
Resource utilization increased with injury severity (see Table 2). Based on the data analysis, literature search, and consensus conference, the authors propose guidelines (see Table 3) for the safe and optimal utilization of resources in routine cases. It is important to emphasize that no recommendation falls outside the 25th percentile of current practice at participating centers.
Conclusions:
Diversity of treatment, with attendant variation in resource utilization in children with isolated spleen and liver injury of comparable severity is confirmed. This analysis has stimulated a prospective outcomes study with the objective of validating the evidence-based guidelines proposed. This evidence-based study design can bring order and conformity to patient management resulting in optimal utilization of resources while maximizing patient safety.
