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Admission for Isolated Low-Grade Solid Organ Injury May Not Be Necessary in Pediatric Patients
Erin Butt1, Meera Kotagal, Kaaren Shebesta
1Division of Pediatric General & Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Pediatric patients with isolated low-grade blunt solid organ injuries can be safely discharged after a brief observation period. This approach avoids unnecessary hospital admissions for minor injuries, improving patient care and resource allocation.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Solid Organ Injury Management
Background:
- Recent literature suggests hemodynamic-focused pathways can safely manage blunt solid organ injuries, reducing hospital stays.
- This study investigates the hypothesis that pediatric patients with isolated blunt Grade I or II solid organ injuries can be discharged after brief observation with outpatient follow-up.
Purpose of the Study:
- To evaluate the necessity of hospital admission for pediatric trauma patients.
- To assess outcomes for isolated low-grade solid organ injuries from blunt trauma in children.
Main Methods:
- Retrospective cohort study using trauma registry data (2011-2018).
- Included children (<19 years) with isolated blunt Grade I or II solid organ injuries.
- Defined "complication or intervention" to include transfusions, ICU transfer, repeat imaging, significant hemoglobin drop, fluid bolus, surgery, or early readmission.
Main Results:
- 51 pediatric patients with isolated Grade I or II blunt solid organ injuries were identified.
- 14% (7/51) experienced "complication or intervention," with no transfusions or surgeries required.
- Common injuries were sports-related (45%); average length of stay was 1 day.
Conclusions:
- No significant interventions were needed for the studied cohort, questioning the necessity of admission.
- Observed complications were of limited clinical significance.
- Recommends emergency department discharge for hemodynamically stable patients with isolated low-grade solid organ injuries after brief observation and appropriate pain management.
Background:
Recent publications indicate that blunt solid organ injuries can be safely managed with reduced length of stay using pathways focused on hemodynamics. We hypothesized that pediatric patients with isolated blunt Grade I or II solid organ injuries may be safely discharged after brief observation with appropriate outpatient follow-up.
Objective:
The purpose of this study is to evaluate the need for admission of pediatric trauma patients with isolated low-grade solid organ injury resulting from blunt trauma.
Methods:
We performed a retrospective cohort study of trauma registry data from 2011 to 2018 to identify isolated blunt Grade I or II solid organ injuries among children younger than 19 years. "Complication or intervention" was defined as transfusions, transfer to the intensive care unit, repeat imaging, decrease in Hgb greater than 2 g/dl, fluid bolus after initial resuscitation, operation or interventional radiology procedure, or readmission within 1 week.
Results:
A total of 51 patients were admitted to the trauma service with isolated Grade I or II blunt solid organ injuries during the 8-year study period. The average age was 11 years. Among isolated Grade I or II injuries, seven (14%) had "complication or intervention" including greater than 2 g/dl drop in Hgb in four patients (8%), follow-up ultrasonography for pain in one patient (2%), readmission for pain in one patient (2%), or a fluid bolus in two patients (4%). None required transfusion or surgery. The most common mechanism of injury was sports related (45%), and the average length of stay was 1 day.
Conclusion:
Among a cohort of 51 patients with isolated blunt Grade I or II solid organ injuries, none required a significant intervention justifying need for admission. All "complication or intervention" patients observed were of limited clinical significance. We recommend that hemodynamically stable patients with isolated low-grade solid organ injuries may be discharged from the emergency department after a brief observation along with appropriate instructions and pain management.
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