Admission For Grade I & II Blunt Solid Organ Injuries. Is It Necessary?
*Erin Butt, *Kaaren Shebesta, *Allison Youngs, *Margot Daughtery, *Suzanne Moody, *Meera Kotagal, *Richard Falcone, Jr.
Cincinnati Children's Hospital, Cincinnati, OH
Background: Recent publications indicate that blunt solid organ injuries can be safely managed with reduced length of stay using pathways focused on hemodynamics. We hypothesized that pediatric patients with isolated blunt grade I/II solid organ injuries may be safely discharged after brief observation with appropriate outpatient follow up.
Methods: We performed a retrospective review of our trauma registry from 2011-2018 to identify isolated blunt grade I/II solid organ injuries among children less than 19 years. “Complications” considered included transfusions, transfer to ICU, repeat imaging, decrease in HgB > 2 gm/dL, fluid bolus after initial resuscitation, OR/IR intervention, or readmission within 1 week.
Results: From 2011-2018, 51 of 3977 admitted trauma services patients with an average age of 12 years had isolated grade I/II blunt solid organ injuries. Among isolated grade I/II injuries 7 (14%) had complications including: >2gm/dl drop in HgB for 4 patients (8%), follow-up ultrasound for pain 1 patient (2%), readmission for pain 1 patient (2%), or a fluid bolus in 2 patients (4%). None required transfusion or surgery. The most common mechanism of injury was sports related at 45% and the average length of stay was 1 day.
Conclusion: Among a cohort of 51 isolated blunt grade I/II solid organ injuries none required a significant intervention justifying need for admission. All “complications” observed were of limited clinical significance. We therefore recommend that hemodynamically stable patients with isolated low grade solid organ injury may be discharged from the emergency room after a brief observation along with appropriate instructions and pain management.
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