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Published on: November 20, 2016
Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven
Aaron J Cunningham1, Katrine M Lofberg2, Sanjay Krishnaswami1
1Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR.
Insights
An expedited pediatric solid organ injury protocol reduced hospital and ICU stays, and phlebotomy use. This approach maintained quality of care while decreasing resource utilization across multiple institutions.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Healthcare Systems Research
Background:
- An expedited recovery protocol was implemented for pediatric blunt solid organ injuries (spleen, liver, kidney) across two Level 1 Trauma Centers.
- The protocol involved nine pediatric surgeons within three hospital systems.
Purpose of the Study:
- To evaluate the effectiveness of an expedited recovery protocol for pediatric blunt solid organ injuries.
- To assess the impact on patient outcomes, hospital resource utilization, and costs.
Main Methods:
- A retrospective cohort study compared 106 patients (55 control, 51 protocol) over two 18-month periods.
- Data included demographics, injury grade, surgeon compliance, complications (NSQIP), hospital costs, length of stay, ICU time, phlebotomy, and readmission.
Main Results:
- The protocol group showed significantly shorter hospital stays (3.5 vs. 4.6 days) and ICU stays (1.0 vs. 1.9 days).
- Total phlebotomy draws were significantly reduced (5.3 vs. 7.7 draws) in the protocol group.
- Complication rates were similar (3.9% vs. 1.8%), with no deaths in either group. Direct hospital costs also decreased ($8795 vs. $11,965).
Conclusions:
- An expedited, hemodynamic-driven protocol for pediatric solid organ injury is feasible across multiple institutions and surgeons.
- The protocol successfully maintained quality of care while reducing length of stay, ICU utilization, phlebotomy, and costs.
- Further research should focus on optimizing resource utilization within such protocols.
Background:
An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems.
Methods:
Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation.
Results:
A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar.
Conclusions:
An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization.
Type Of Study:
Retrospective cohort study.
Level Of Evidence:
Level II.
