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Is early discharge following isolated splenic injury in the hemodynamically stable child possible?
J M Lynch1, H Ford, M J Gardner
1Department of Pediatric Surgery, Benedum Pediatric Trauma Program, Children's Hospital of Pittsburgh, PA 15213-2583.
Insights
Hemodynamically stable patients with splenic injuries can be monitored effectively without intensive care. Hospitalization can be shortened to approximately seven days after hematocrit levels stabilize, optimizing resource use.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Radiology
Background:
- Nonoperative management of splenic injuries is a recognized treatment.
- Optimal monitoring intensity and hospital length of stay for hemodynamically stable patients remain unclear.
Purpose of the Study:
- To determine appropriate monitoring intensity for hemodynamically stable patients with splenic injuries.
- To establish recommended hospitalization duration for these patients.
Main Methods:
- Retrospective review of 53 hemodynamically stable patients with splenic injuries treated nonoperatively between 1986 and 1991.
- Utilized computed tomography (CT) classification and serial hematocrit monitoring.
- Assessed outcomes including transfusion needs, complications, and length of stay.
Main Results:
- The average time to hematocrit stability was 2.06 days.
- The average hospital stay was 7.06 days.
- Complications were minimal, with most patients discharged after imaging confirmed healing.
Conclusions:
- Hemodynamically stable patients with splenic injuries require less intensive monitoring after hematocrit stabilization.
- A hospital stay of approximately seven days is sufficient, allowing for bed space and healthcare cost optimization.
Abstract:
Nonoperative treatment of splenic injury is well accepted. Two questions have not been answered. (1) What is the intensity of monitoring required in the hemodynamically stable patient? (2) How long do patients need to be hospitalized? Ninety-one patients having computed tomography (CT) or surgically proven splenic injury were treated between September 1986 and September 1991. Excluded from the study were 16 patients requiring operation and 22 patients having multiple system injuries. All operations occurred within 24 hours of admission. No transfusions were required later than 48 hours following admission. The remaining 53 patients (58%) constitute the study group. CT classification of Buntain indicated 6 class I, 21 class II, 24 class III, and 2 class IV injuries. The mean Injury Severity Score (ISS) for the group was 6.98 +/- 3.43. Serial hematocrits for the patients treated without transfusions were followed until three consecutive determinations showed no change. The lowest average hematocrit for the nontransfused group was 30.96% +/- 4.47% and occurred on day 2.06 +/- 0.76. Eleven patients (23%) had left-sided pleural effusions that resolved without intervention. One patient had an ileus for 3 days. CT or ultrasound examination was obtained on day 5 to 7 to document healing before the patient was allowed out of bed and discharged. The average hospital stay was 7.06 +/- 2.24 days. Twenty-two patients were initially observed in the intensive care unit (ICU). Clearly the interval between hematocrit stability (average, 2.06 days) and discharge (average, 7.06 days) constitutes a time of minimal nursing care while utilizing bed space and health care dollars.(ABSTRACT TRUNCATED AT 250 WORDS)