Abstract
Purpose
Recent reports suggest that an abbreviated bed rest protocol (ABRP) may safely reduce
length of stay (LOS) and resource utilization in pediatric blunt spleen and liver
injury (BSLI) patients. This study evaluates national temporal trends in BLSI management
and estimates national reduction in LOS using an ABRP.
Methods
Pediatric patients (<18 years old) sustaining BLSI were identified in the Kids’ Inpatient Database from
2000 to 2009. Yearly rates of injury and operative intervention were examined and
stratified by type of injury. APSA guidelines and the reported ABRP were applied based
on abbreviated injury score (AIS) and compared with actual LOS.
Results
22,153 patients were identified. Over the study period, operative rates for spleen
and liver injuries and overall mortality significantly declined: LOS = 3.1 days (±1.6) and 2.7 days (±1.9) for spleen and liver, respectively. If APSA guidelines were followed, the rates
were LOS = 3.7 days (±1.1) and 3.4 days (±0.7), respectively. Application of the ABRP would result in LOS = 1.3 days (±0.5) for all BSLI patients. An ABRP could potentially save 1.7 hospital days/patient
or 36,964 patient hospital days nationally.
Conclusion
Our study confirms a significant national decrease in operative intervention and overall
mortality in patients with BSLI. Additionally, it appears that a shorter observation
period than the APSA guidelines is being utilized. The implementation of ABRP holds
potential in further reducing LOS and resource utilization.
Key words
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Article info
Publication history
Published online: February 24, 2014
Accepted:
January 27,
2014
Received:
January 25,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
