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J Pediatr Surg. 2017 May;52(5):826-831. doi: 10.1016/j.jpedsurg.2017.01.037. Epub 2017 Jan 29.

Outcomes of an accelerated care pathway for pediatric blunt solid organ injuries in a public healthcare system.

Author information

1
Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
2
Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
3
Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada.
4
Section of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: Steven.Lopushinsky@albertahealthservices.ca.

Abstract

PURPOSE:

An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed.

METHODS:

Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest.

RESULTS:

138 patients with solid organ injury were studied: 73 pre- (2012-2014) and 65 post-protocol (2014-2015). There were no significant differences in age, gender, injury severity score (ISS), injury grade, or mechanism (p>0.05). LOS was shorter post-protocol (mean 5.6 vs. 3.4days; median 5 .0 vs. 3.0days; p=0.0002), resulting in average savings of $5966 per patient. Patients in the protocol group mobilized faster (p<0.0001) and experienced fewer blood draws (p=0.02). On multivariate analysis, protocol group (p<0.001) and ISS (p<0.001) were independently associated with LOS. There were no differences between groups in the need for operation, embolization, or transfusion.

CONCLUSION:

An accelerated care pathway is safe and effective in the management of pediatric solid organ injuries with early mobilization, less blood draws, and decreased LOS without significant morbidity and mortality.

LEVEL OF EVIDENCE:

Therapeutic, cost effectiveness, level III.

KEYWORDS:

Kidney injury; Liver injury; Management; Pediatric; Spleen injury

PMID:
28188036
DOI:
10.1016/j.jpedsurg.2017.01.037
[Indexed for MEDLINE]

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