Related Experiment Video
Updated: Apr 29, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Reducing scheduled phlebotomy in stable pediatric patients with blunt liver or spleen injury
Jamie Golden1, Ian Mitchell1, Sally Kuzniewski1
1Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Insights
A new pathway for pediatric liver/spleen injuries reduces blood draws and intensive care unit (ICU) admissions. This approach uses clinical parameters, suggesting serial phlebotomy may be unnecessary for managing these injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Clinical Pathway Development
Background:
- Established guidelines exist for pediatric liver and spleen injuries.
- Optimal frequency for phlebotomy (blood draws) in these patients remains undetermined.
- Current practices may involve excessive blood testing.
Purpose of the Study:
- To propose and evaluate a novel management pathway for pediatric solid organ injuries.
- Hypothesize that current phlebotomy frequency exceeds necessity.
- Aim to reduce resource utilization through a streamlined approach.
Main Methods:
- Retrospective analysis of 120 pediatric solid organ injury cases from two hospital registries (2008-2012).
- Comparison of resource utilization between current management and a proposed pathway.
- Statistical analysis using paired t-test to assess differences.
Main Results:
- Sixty-one patients (35 spleen, 22 liver, 4 combined) were analyzed.
- The proposed pathway could decrease intensive care unit (ICU) admissions by 65% and blood draws by 70%.
- Length of stay decreased by 37%, with all transfusions identified via hemodynamic status.
Conclusions:
- Clinical parameters can effectively identify pediatric patients needing intervention for liver/spleen injuries.
- Serial phlebotomy appears unnecessary, potentially reducing resource utilization.
- The proposed pathway warrants prospective validation for clinical implementation.
Background/Purpose:
Although consensus-based guidelines exist for managing pediatric liver/spleen injuries, optimal phlebotomy frequency is unknown. We hypothesize surgeons order more phlebotomy than necessary and propose a pathway with one blood draw, early ambulation and discharge, fewer ICU admissions, and physiology-driven interventions.
Methods:
Records of 120 children with solid organ injury from two hospital registries (2008-2012) were analyzed. We compared resource utilization between our current management and management if the proposed pathway were in place. Paired t-test was used for statistical analysis.
Results:
Sixty-one patients were included (35 spleen, 22 liver, 4 combined). Average age was 11.6 (±4.2) years, injury severity score 9 (±5), and median injury grade 3. 51% of children were admitted to the ICU. Average phlebotomy per patient was 5 (±2) and length-of-stay 4.3 (±1.5) days. Three patients became unstable and required transfusion. No patients required operation or angioembolization. Our pathway would decrease ICU admissions by 65% (p<0.001), blood draws by 70% (p<0.001), and length-of-stay by 37% (p<0.001), while identifying all patients requiring transfusion based on hemodynamic status.
Conclusion:
Our data suggest that clinical parameters could identify patients requiring intervention and decrease resource utilization. This suggests that serial phlebotomy may be unnecessary, and the proposed pathway is worthy of prospective validation.
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism