Discharging Stable Isolated Blunt Solid Organ Injuries From the Emergency Department: A Tertiary Center Study.

Area of Science:

• Pediatric Trauma Surgery
• Emergency Medicine
• Abdominal Imaging

Background:

• Current guidelines for discharging pediatric patients with stable solid organ injuries (SOIs) require ambulation and oral intake.
• No established standard of care exists for discharging patients with stable isolated grade SOIs directly from the emergency department (ED).

Purpose of the Study:

• To evaluate the safety and feasibility of discharging pediatric patients with isolated grades I-III solid organ injuries directly from the ED.

Main Methods:

• A prospective observational study was conducted at a level 1 pediatric trauma center.
• Included patients were under 18 years old with grades I-III blunt traumatic SOIs.
• Exclusion criteria included nonaccidental trauma, blood transfusion, angioembolization, or prior operative management.

Main Results:

• 36 (20%) of 178 eligible children with stable SOIs were discharged from the ED.
• The median length of stay was 6 hours.
• Three patients (8%) returned to the ED, none requiring intervention, readmission, or experiencing major complications.

Conclusions:

• Children with isolated American Association for the Surgery of Trauma (AAST) grades I-III SOIs and normal hemodynamics can be safely discharged from the ED after observation.
• Direct ED discharge is a safe strategy, with a low rate of return visits and no major adverse events.