Disposition Patterns in Children With Low-Acuity Blunt Solid Organ Injury: An NTDB Analysis

Pediatric blunt solid organ injury (SOI) involving liver, spleen, or kidney is common. Contemporary guidelines emphasize physiologic status and clinical course rather than injury grade for management and disposition decisions. We evaluated factors associated with emergency department (ED) discharge versus short uncomplicated admission among children with low-severity blunt SOI.

We conducted a retrospective cohort study using the 2017-2023 National Trauma Data Bank. Patients aged ≤18 y with blunt liver, spleen, and/or kidney injury, SOI Abbreviated Injury Scale severity ≤3, Injury Severity Score ≤15, and no severe nonabdominal injury were included. Short uncomplicated admission was retrospectively defined as hospital stay ≤2 d, discharge home, no intensive care unit admission, transfusion, angiographic intervention, operation, or in-hospital complication. Staged logistic regression was supplemented by overlap-weighted and Firth penalized analyses.

Among 5749 patients, 352 (6.1%) were discharged from the ED and 5397 (93.9%) underwent short uncomplicated admission. SOI Abbreviated Injury Scale severity 3 (aOR 2.33, 95% CI 1.58-3.43) and multi-organ injury (aOR 2.67, 95% CI 1.40-5.93) were associated with higher odds of admission. Injury Severity Score category and physiologic variables were not significant. White race and pediatric trauma center care were associated with higher odds of admission, whereas older age, private insurance, and private vehicle transport were associated with lower odds. Confirmatory analyses produced similar estimates.

Among captured National Trauma Data Bank cases meeting the analytic criteria, ED discharge was uncommon. Disposition was associated with anatomic, demographic, and system-level characteristics. Prospective studies are needed to define and validate safe, consistently applied ED discharge criteria among selective low-severity SOI patients.