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Isolated Solid Organ Injuries in Children: To Bedrest or Not to Bedrest? That is the Question!
Jillian Walsh, MD, Pierre Schmit, and Natalie L. Yanchar, MD, IWK Health Centre, Halifax NS

Abstract: Background: Management of solid organ injuries (SOI) in children is often predicated on radiologic grade of injury. Hypothesizing that grade may not necessarily determine hospitalization need, we investigated factors associated with hospitalization in cases of isolated SOI in children. Methods: Retrospective review of all cases admitted to one pediatric trauma center over 10yrs revealed 89 cases with SOI established by CT scan upon admission. Review of all scans by one pediatric radiologist was performed to determine SOI grade. Chi square and Fisher’s tests were used to determine associations with presenting clinical features and SOI grade with early outcomes. Results: Forty-three cases of isolate SOI (33 spleen, 10 liver, 8 kidney) were identified. Of these, 10 were grades 1-2 and 33 grades 3-5. Variables associated with length of stay>2days were admission Hct<33 (p=0.006) and need for narcotics or antiemetics upon admission (p=0.002; p<0.0001). Significant associations between these features and need for narcotics or antiemetics the following day were also observed. No features predicted a significant drop in Hct over the first 24hrs or need for transfusion. Nineteen patients did not require narcotics, antiemetis or transfusions; 11 of these stayed in hospital≤2d. CT grade was not predictive of any short term outcomes. Conclusions: Clinical status, low admission Hct and need for medications may be better predictors of admission requirements of patients with isolated SOI than CT grade. Brief ED observation and discharge home may be appropriate for stable patients with isolated BAT without concerning clinical features, despite findings of SOI on imaging.

Objective: To discuss the utility of basing management of isolated solid organ injury based on clinical versus radiologic grade criteria.

Objective Content: At the end of this activity, the learner will be able to critically evaluate the role of admission and bedrest in pediatric patients sustaining solid organ injury.


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