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Can we safely decrease intensive care unit admissions for children with high grade isolated solid organ injuries?
Mary Arbuthnot1, Lindsey Bendure Armstrong1, David P Mooney1
1Boston Children's Hospital, Department of Surgery, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115, United States.
Journal of Pediatric Surgery
|April 3, 2017
Summary
Pediatric blunt solid organ injuries can be safely managed by limiting intensive care unit (ICU) admission to children with an elevated shock index for pediatric age-adjusted (SIPA) or low hematocrit. This approach reduces ICU admissions by two-thirds.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Critical Care Medicine
Background:
- Established guidelines recommend intensive care unit (ICU) admission for pediatric patients with grade IV blunt liver and splenic injuries.
- There is a need to refine criteria for ICU admission in children with isolated solid organ injuries (SOI).
Purpose of the Study:
- To identify predictors of ICU-level interventions in children with isolated blunt SOI.
- To determine if the shock index for pediatric age-adjusted (SIPA) and hematocrit can guide ICU admission decisions.
Main Methods:
- A retrospective review of pediatric patients with isolated liver, spleen, or kidney injuries admitted to the ICU between November 2003 and August 2015.
- ICU-level interventions included transfusion, vasopressor use, intubation, and operative/procedural intervention.
- Sensitivity and negative predictive values (NPV) were calculated for elevated SIPA or hematocrit <30%.
Main Results:
- 133 children met inclusion criteria; 19% required ICU-level intervention.
- An elevated SIPA or hematocrit <30% was present in 95% of the intervention group versus 22% of the non-intervention group.
- The sensitivity was 95% and the NPV was 99% for these criteria.
Conclusions:
- Limiting ICU admission to children with isolated SOI and either an elevated SIPA or hematocrit <30% can significantly reduce ICU admission rates.
- This strategy can decrease ICU admissions by two-thirds while maintaining patient safety.
- SIPA and hematocrit are valuable tools for predicting the need for ICU-level intervention in pediatric SOI.