Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study

Background An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. Methods Data were collected for 18 months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. Results A total of 106 patients were treated (control = 55, protocol = 51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5 days, p = 0.04), ICU stay (1.9 vs. 1.0 days, p = 0.02), and total phlebotomy (7.7 vs. 5.3 draws, p = 0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p = 0.09). Complication rates (1.8% vs. 3.9%, p = 0.86, no deaths) were similar. Conclusions An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. Type of study Retrospective cohort study. Level of evidence Level II.