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Validation for Abbreviated Hospital Stay in Pediatric Patients with Solid Organ Injury
Kristine L Griffin1, Chandler Richardson2, Stephanie Brierley2
1Prisma Health Upstate, Greenville, SC, USA.
Insights
Pediatric solid organ injuries can be safely managed with shorter hospital stays by focusing on clinical stability, not just injury grade. This approach reduces length of stay for children with isolated injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Clinical Outcomes
Background:
- Established guidelines recommend length of stay (LOS) based on injury grade plus one day.
- Previous studies on earlier discharge were confounded by multiple injuries.
- This study focuses on isolated pediatric solid organ injuries.
Purpose of the Study:
- To evaluate length of stay (LOS) and outcomes in pediatric patients with isolated solid organ injuries.
- To determine if clinical and hemodynamic factors allow for earlier discharge than current guidelines suggest.
- To analyze factors influencing LOS in this specific patient population.
Main Methods:
- Retrospective review of 156 pediatric patients over 12 years.
- Inclusion criteria: isolated kidney, liver, or spleen trauma.
- Exclusion criteria: associated injuries affecting LOS (neurologic, orthopedic, etc.).
- Hemodynamic parameters were assessed for patient stability.
Main Results:
- Actual average LOS was 2.85 days, compared to a projected 3.71 days based on guidelines.
- Need for surgery, ICU admission, and transfusions increased LOS.
- Episodes of abnormal vital signs positively correlated with longer LOS.
Conclusions:
- Management based on hemodynamic parameters and clinical status is safe for isolated solid organ injuries.
- Consistently normal vital signs support earlier discharge.
- This approach effectively reduces hospital length of stay in pediatric trauma patients.
Background:
In 2000, the American Pediatric Surgical Association (APSA) published guidelines for the management of pediatric solid organ injury, recommending a hospital length of stay (LOS) of grade of injury plus 1 day. Since the publication of these guidelines, several studies have suggested that it is safe to discharge patients sooner based upon hemodynamic and clinical factors. The results of several of these studies have been confounded by the existence of other injuries. The aim of this study was to examine LOS and outcomes in children with strictly isolated solid organ injuries.
Materials And Methods:
This is a 12-year retrospective review of pediatric patients with isolated trauma to the kidney, liver, or spleen to determine LOS. Patients were excluded for associated intracranial, neurologic, orthopedic, or pulmonary injuries which would impact length of stay. Documented hemodynamic parameters were reviewed as determinants of patient stability.
Results:
A total of 156 patients were included in the study. The projected average LOS for all patients based on the 2000 APSA guidelines would have been 3.71 ± 0.98 days. The actual average LOS for all patients 2.85 ± 3.32 days. Need for operation, ICU stay, and transfusion all contributed to increased LOS. The number of episodes of abnormal vitals positively correlated with increased LOS.
Discussion:
This study validates that management of isolated solid organ injuries based upon hemodynamic parameters and clinical status is safe and decreases hospital length of stay. Consistently normal vital signs indicate these children can be safely discharged sooner.
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