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

Aaron J. Cunningham, Katrine M. Lofberg, Sanjay Krishnaswami, Marilyn W. Butler, Kenneth S. Azarow, Nicholas A. Hamilton, Elizabeth A. Fialkowski, Pamela Bilyeu, Erika Ohm, Erin C. Burns, Margo Hendrickson, Preetha Krishnan, Cynthia Gingalewski, Mubeen A. Jafri

Research output: Research - peer-reviewArticle

Abstract

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.

LanguageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Phlebotomy
Length of Stay
Hemodynamics
Pediatrics
Wounds and Injuries
Surgeons
Hospital Costs
Compliance
Demography
Trauma Centers
Quality Improvement
Cohort Studies
Spleen
Retrospective Studies
Kidney
Costs and Cost Analysis
Liver

Keywords

  • Abdominal injury
  • Hemodynamic
  • Nonoperative management
  • Protocol
  • Solid organ injury
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol : A multi-institution study. / Cunningham, Aaron J.; Lofberg, Katrine M.; Krishnaswami, Sanjay; Butler, Marilyn W.; Azarow, Kenneth S.; Hamilton, Nicholas A.; Fialkowski, Elizabeth A.; Bilyeu, Pamela; Ohm, Erika; Burns, Erin C.; Hendrickson, Margo; Krishnan, Preetha; Gingalewski, Cynthia; Jafri, Mubeen A.

In: Journal of Pediatric Surgery, 2017.

Research output: Research - peer-reviewArticle

@article{321c21e7c9954f878dc3aac5fe987312,
title = "Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: A multi-institution study",
abstract = "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.",
keywords = "Abdominal injury, Hemodynamic, Nonoperative management, Protocol, Solid organ injury, Trauma",
author = "Cunningham, {Aaron J.} and Lofberg, {Katrine M.} and Sanjay Krishnaswami and Butler, {Marilyn W.} and Azarow, {Kenneth S.} and Hamilton, {Nicholas A.} and Fialkowski, {Elizabeth A.} and Pamela Bilyeu and Erika Ohm and Burns, {Erin C.} and Margo Hendrickson and Preetha Krishnan and Cynthia Gingalewski and Jafri, {Mubeen A.}",
year = "2017",
doi = "10.1016/j.jpedsurg.2017.08.035",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol

T2 - Journal of Pediatric Surgery

AU - Cunningham,Aaron J.

AU - Lofberg,Katrine M.

AU - Krishnaswami,Sanjay

AU - Butler,Marilyn W.

AU - Azarow,Kenneth S.

AU - Hamilton,Nicholas A.

AU - Fialkowski,Elizabeth A.

AU - Bilyeu,Pamela

AU - Ohm,Erika

AU - Burns,Erin C.

AU - Hendrickson,Margo

AU - Krishnan,Preetha

AU - Gingalewski,Cynthia

AU - Jafri,Mubeen A.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Abdominal injury

KW - Hemodynamic

KW - Nonoperative management

KW - Protocol

KW - Solid organ injury

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=85029656473&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029656473&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2017.08.035

DO - 10.1016/j.jpedsurg.2017.08.035

M3 - Article

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -