Related Experiment Video
Updated: Aug 25, 2026
Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions
Published on: December 20, 2024
Application of the APSA evidence-based guidelines for isolated liver or spleen injuries: a single institution
Michael J Leinwand1, Carole C Atkinson, David P Mooney
1Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Insights
Implementing clinical practice guidelines (CPGs) for pediatric liver and spleen injuries reduced intensive care unit (ICU) and hospital stays. This approach also decreased resource utilization without impacting patient outcomes.
Area of Science:
- Pediatric Surgery
- Clinical Practice Guidelines
- Trauma Management
Background:
- The American Pediatric Surgical Association (APSA) established evidence-based guidelines in 1998 for managing hemodynamically stable pediatric patients with isolated liver or spleen injuries.
- A clinical practice guideline (CPG) was developed based on these APSA recommendations to standardize care.
Purpose of the Study:
- To evaluate the impact of implementing an APSA-based CPG on the management of pediatric patients with isolated liver or spleen injuries.
- To analyze changes in resource utilization and patient outcomes following CPG implementation at a single institution.
Main Methods:
- A retrospective cohort study compared patients treated with the CPG (September 1998 - June 2002) to a pre-CPG cohort (February 1992 - October 1997).
- Data analyzed included patient demographics, injury severity, hematocrit levels, intensive care unit (ICU) and hospital length of stay, and follow-up imaging.
Main Results:
- CPG implementation led to significantly shorter ICU stays (0.4 vs. 1.4 days) and hospital stays (3.8 vs. 7.2 days).
- Fewer hematocrit measurements (4.7 vs. 9.2) and follow-up imaging studies (0.3 vs. 2.1) were performed in the CPG group.
- No urgent operations were required in either group, and one patient in the CPG group was readmitted for delayed hemorrhage.
Conclusions:
- The application of an APSA-based CPG effectively reduced ICU and hospital lengths of stay for pediatric patients with isolated liver or spleen injuries.
- CPG implementation resulted in decreased resource utilization, including fewer laboratory tests and imaging studies.
- The study demonstrated that adherence to the CPG did not adversely affect patient outcomes.
Purpose:
In 1998, the American Pediatric Surgical Association (APSA) recommended evidence-based guidelines for the management of hemodynamically stable patients with isolated liver or spleen injuries. A clinical practice guideline (CPG) was developed using the APSA guidelines. This study analyzes the impact of the CPG on the care of these children in a single institution.
Methods:
Patients treated with the CPG between September 1998 and June 2002 were compared with a similar cohort admitted from February 1992 to October 1997, before the CPG was instituted. Groups were analyzed for age, computerized tomographic organ injury grade, hematocrits obtained, Injury Severity Score (ISS), length of intensive care unit (ICU) and hospital stay, follow-up imaging studies performed, and outcome.
Results:
CPG patients had a shorter ICU length of stay (0.4 +/- 0.6 v 1.4 +/- 0.6 days; P <.001), shorter hospital stay (3.8 +/- 1.2 v 7.2 +/- 1.4 days; P <.001), fewer hematocrits obtained (4.7 +/- 2.2 v 9.2 +/- 3.1; P <.001), and fewer follow-up imaging studies (0.3 +/- 0.4 v 2.1 +/- 1.1; P <.001). One patient in the CPG group was readmitted for delayed hemorrhage. No urgent operations were performed in either group.
Conclusions:
Application of an APSA-based CPG resulted in decreased length of ICU stay, decreased hospital stay, and decreased resource utilization without any noted effect on outcome.
