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Continuous Hemoglobin Monitoring in Pediatric Patients with Solid Organ Injury
Jennifer Novak, MD1, Emily Welker, MD1, Lindsey Jelsma, DNP2, Todd Nickoles, MSN2, Tracy Koehler, PhD3, Allen Davis, PhD3, James DeCou, MD2, Emily Durkin, MD2. 1Michigan State University, College of Human Medicine, Grand Rapids, MI, USA, 2Helen DeVos Children's Hospital, Grand Rapids, MI, 3Grand Rapids Medical Education Partners, Grand Rapids, MI, USA.

Non-invasive hemoglobin monitoring (NIHM) is an alternative to serial laboratory hemoglobin (LabHb) studies but has not been previously studied in the pediatric trauma population. We hypothesized that NIHM represents a safe and effective method of hemoglobin level monitoring in hemodynamically stable pediatric trauma patients. A retrospective cohort study was performed on pediatric trauma patients (< 18 years-old) with blunt solid organ injury admitted to a level I pediatric trauma center over a consecutive six month period. LabHb measurements were obtained, and continuous NIHM was initiated on all patients at the time of admission (Radical-7 Pulse Co-oximeter, Masimo Corporation, Irvine, CA). LabHb values were correlated with monitor NIHM values measured within one hour of each other. Twenty-three patients met inclusion criteria for analysis. Patient injury characteristics were similar (spleen 35%, liver 39%, kidney 22%) with a mean injury severity score of 17.7 for the cohort. Bland Altman analysis showed a mean deviation of 0.58 gm/dL between NIHM and LabHb values for all data pairs (limits of agreement between -2.30 to 3.46, 95th CI). Individual measurement trends were highly correlated in patients with stable hemoglobin measurements and in those that required blood transfusion. No patients required laparotomy or percutaneous intervention for hemorrhage control, and the average length of hospital stay was 5 days (range 1-28 days). NIHM demonstrates clinically acceptable accuracy when following hemoglobin trends over time in hemodynamically stable pediatric trauma patients. Continuous NIHM represents a valuable adjunct to traditional laboratory hemoglobin monitoring for pediatric patients with blunt solid organ injury.


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