Reducing scheduled phlebotomy in stable pediatric patients with blunt liver or spleen injury

Jamie Golden, Ian Mitchell, Sally Kuzniewski, Aaron Lipskar, Jose M. Prince, Matthew Bank, Steven Stylianos, Nelson G. Rosen

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background/Purpose Although consensus-based guidelines exist for managing pediatric liver/spleen injuries, optimal phlebotomy frequency is unknown. We hypothesize surgeons order more phlebotomy than necessary and propose a pathway with one blood draw, early ambulation and discharge, fewer ICU admissions, and physiology-driven interventions. Methods Records of 120 children with solid organ injury from two hospital registries (2008-2012) were analyzed. We compared resource utilization between our current management and management if the proposed pathway were in place. Paired t-test was used for statistical analysis. Results Sixty-one patients were included (35 spleen, 22 liver, 4 combined). Average age was 11.6 (± 4.2) years, injury severity score 9 (± 5), and median injury grade 3. 51% of children were admitted to the ICU. Average phlebotomy per patient was 5 (± 2) and length-of-stay 4.3 (± 1.5) days. Three patients became unstable and required transfusion. No patients required operation or angioembolization. Our pathway would decrease ICU admissions by 65% (p < 0.001), blood draws by 70% (p < 0.001), and length-of-stay by 37% (p < 0.001), while identifying all patients requiring transfusion based on hemodynamic status. Conclusion Our data suggest that clinical parameters could identify patients requiring intervention and decrease resource utilization. This suggests that serial phlebotomy may be unnecessary, and the proposed pathway is worthy of prospective validation.

Original languageEnglish (US)
Pages (from-to)759-762
Number of pages4
JournalJournal of pediatric surgery
Volume49
Issue number5
DOIs
StatePublished - May 2014
Externally publishedYes

Keywords

  • Liver injury
  • Pediatric
  • Phlebotomy
  • Resource utilization
  • Spleen injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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