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The use of an institutional pediatric abdominal trauma protocol improves resource use

Sara C Fallon1, David Delemos, Adesola Akinkuotu

  • 1From the Division of Pediatric Surgery (S.C.F, A.A., B.J.N.-M.), Michael E. DeBakey Department of Surgery, and Division of Pediatric Emergency Medicine (D.D., D.C.), Department of Emergency Medicine, Baylor College of Medicine; and Trauma Services (D.D., D.C., B.J.N.-M.), Texas Children's Hospital, Houston, Texas.

The Journal of Trauma and Acute Care Surgery
|December 20, 2015
PubMed

Insights

A new protocol for pediatric abdominal trauma management reduced unnecessary CT scans and laboratory costs. This improved patient safety and resource utilization in the emergency center.

Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Health Services Research

Background:

  • A novel protocol was developed to standardize emergency center (EC) management of abdominal trauma in children.
  • The protocol aimed to improve patient safety by reducing computed tomography (CT) radiation exposure.
  • The study also sought to enhance care quality by decreasing EC length of stay (LOS) and laboratory costs.

Purpose of the Study:

  • To evaluate the effectiveness of a standardized EC protocol for pediatric abdominal trauma.
  • To determine if the protocol decreased unnecessary CT scans and associated radiation.
  • To assess the protocol's impact on EC LOS and laboratory expenses.

Main Methods:

  • A prospective, longitudinal study was conducted on pediatric patients with abdominal trauma requiring CT scans.
  • Patients were analyzed across three periods: preimplementation, Postimplementation 1, and Postimplementation 2.
  • Outcome measures included protocol adherence, CT results, EC LOS, and laboratory costs, analyzed using chi-squared and ANOVA tests.

Main Results:

  • Protocol adherence improved over time, reaching 82% in Postimplementation 2.
  • The rate of positive CT scan results significantly increased from 23% to 46% (p=0.003).
  • Clinically significant scans were more frequent when the protocol was followed (31% vs. 8%, p=0.001), while EC LOS remained unchanged. Laboratory costs decreased significantly in Postimplementation 2 (p=0.005).

Conclusions:

  • An institutional abdominal trauma management algorithm effectively improves resource utilization.
  • The protocol successfully reduced unnecessary computed tomography (CT) scan use.
  • The implemented algorithm also led to a decrease in laboratory costs for pediatric abdominal trauma patients.
Abstract

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