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Reducing Blood Draws in Pediatric Patients With Solid Organ Injury Through Protocolized Transcutaneous Hemoglobin
Arya Payan1, Megan Coble2, Benjamin Kowalske2
1Department of Pediatric Critical Care, Corewell Health Helen DeVos Children's Hospital, Grand Rapids, MI, USA.
Insights
Transcutaneous continuous hemoglobin monitoring (TCHM) safely reduces blood draws in pediatric solid organ injury patients. This technology minimizes invasive procedures without increasing adverse events or operative interventions.
Area of Science:
- Pediatric Trauma Care
- Hemoglobin Monitoring Technologies
- Solid Organ Injury Management
Background:
- Pediatric solid organ injury management is evolving to reduce interventions.
- Transcutaneous continuous hemoglobin monitoring (TCHM) shows promise for monitoring hemoglobin in pediatric trauma.
Purpose of the Study:
- To evaluate the safety and efficacy of a protocolized TCHM system in pediatric solid organ injury patients.
- To assess the impact of TCHM on laboratory blood draws and adverse events.
Main Methods:
- Retrospective chart review of 97 pediatric patients (30 days to <18 years) with solid organ injury.
- Implementation of a protocolized TCHM system.
- Tracking of adverse events including blood product administration, line placement, and operative intervention.
Main Results:
- Significantly reduced laboratory blood draws post-TCHM protocol implementation (p=0.01).
- No significant increase in blood product administration, line placement, or operative intervention.
- Length of stay remained unaffected.
Conclusions:
- TCHM, within a defined protocol, safely decreases serial blood draws in pediatric trauma patients with solid organ injury.
- Further research is needed to explore TCHM's potential in reducing hospital admission for low-grade injuries.
Background:
Management of pediatric solid organ injuries continues to evolve, decreasing the need for serial hemoglobin measurements, repeat imaging, and operative intervention. Transcutaneous continuous hemoglobin monitoring (TCHM) has been shown to effectively monitor hemoglobin levels in children with solid organ trauma.
Methods:
A 6-year, single-center, retrospective chart review was conducted of pediatric solid organ injury patients aged 30 days to <18 years admitted to a quaternary children's hospital following implementation of a highly protocolized TCHM system. A laboratory hemoglobin measurement was obtained at the time of diagnosis and additional measurements were determined based on injury grading. Adverse events were tracked and included: central or arterial line placement, blood product(s) administration, percutaneous embolization procedures, transfer to the pediatric ICU and operative intervention.
Results:
A total of 97 patients met the inclusion criteria. Blood draws were significantly reduced following TCHM protocol implementation (3.0 [IQR 2.0-5.5] vs 2.0 [IQR 1.0-4.5], p 0.01) without a significant increase in blood product administration (p = 0.30), central or arterial line placement (p = 1), or operative intervention (p = 0.29). Length of stay was not impacted (p = 0.36). The rate of unplanned ICU transfers and percutaneous embolization procedures were too low for statistical evaluation.
Conclusion:
TCHM safely reduces the need for serial blood draws in pediatric trauma patients when utilized within a well-defined protocol for solid organ injury. Further studies are needed to evaluate the role of TCHM in shortening or eliminating hospital admission for low-grade solid organ injuries in children.
Level Of Evidence:
Level III.
Type Of Study:
Single-center, retrospective chart review cohort study.
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