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

The current guidelines for discharging pediatric patients with stable solid organ injuries (SOIs) managed nonoperatively include normal hemodynamics, successful oral intake trial, and ambulation. There is currently no established standard of care for patients with stable isolated grade SOIs to be discharged directly from the emergency department (ED).

A prospective observational study was conducted at a level 1 pediatric trauma center from 2019 to 2025. The inclusion criteria were patients of <18 y old with grades I-III blunt traumatic SOIs of the liver, spleen, kidney, and pancreas. The exclusion criteria were nonaccidental traumatic injuries, patients who required blood transfusion, angioembolization, and operative management for major intra-abdominal injury prior to transfer to our facility. The primary outcome was discharge from the ED. The secondary outcomes were 90-d return to the ED, readmission, morbidity, and mortality.

A total of 178 children met the inclusion criteria. Of these, 36 (20%) with grades I-III stable SOIs were discharged from the ED after a period of observation with normal hemodynamics. The distribution of SOIs includes 10 (28%) American Association for the Surgery of Trauma (AAST) grade I injuries, 20 (56%) AAST grade II injuries, and six (17%) AAST grade III injuries that were discharged from the ED. The median length of stay was 6 h. Three patients (8%) of the ED discharges represented to the ED. None required intervention, readmission, or had major complications.

Children with isolated AAST grades I-III SOIs with normal hemodynamics after a blunt trauma can be safely discharged directly from the ED after a period of observation. Only a small number of patients returned to the ED, and no children required intervention or readmissions.