Opportunity for Reduction of Intensive Care Unit Resource Utilization in Pediatric Blunt Liver and Spleen Injuries: A National Trauma Data Bank Analysis

Theodore Wang; Paul Truche; Rachel Sachs; Arunachalam Thenappan; Yi-Horng Lee; Sathyaprasad C Burjonrappa

doi:10.1016/j.jpedsurg.2024.03.017

Opportunity for Reduction of Intensive Care Unit Resource Utilization in Pediatric Blunt Liver and Spleen Injuries: A National Trauma Data Bank Analysis

J Pediatr Surg. 2024 Mar 16:S0022-3468(24)00168-4. doi: 10.1016/j.jpedsurg.2024.03.017. Online ahead of print.

Authors

Theodore Wang¹, Paul Truche², Rachel Sachs², Arunachalam Thenappan², Yi-Horng Lee², Sathyaprasad C Burjonrappa³

Affiliations

¹ Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
² Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, NJ, USA.
³ Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: Sb2058@rutgers.edu.

PMID: 38575447
DOI: 10.1016/j.jpedsurg.2024.03.017

Abstract

Introduction: Guidelines for blunt liver and spleen injury (BLSI) by the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) emphasize hemodynamic stability over injury grade when considering non-operative management (NOM). In this study, we examined rates of intensive care unit (ICU) admission for children with isolated low-risk BLSI among US hospitals.

Methods: The National Trauma Data Bank (NTDB) was queried for patients ages 1-15 admitted between 2017 and 2019 with BLSI. Patients with penetrating injuries and/or concomitant non-abdominal injuries with AIS score ≥3 were excluded. Isolated BLSI was considered low-risk if the patient had normal admission vitals and did not require operative intervention. Primary outcomes measured were ICU admission, ICU length of stay (LOS), and overall LOS.

Results: 5777 patients ages 15 and under presented with isolated BLSI during the study period. 2031/5777 (35.2%) were considered low-risk. Low-risk patients had lower rates of ICU admission compared to high-risk patients (30.9% vs. 41.6%, p < 0.001) and had shorter ICU LOS (median 2 days vs. 2, p < 0.001) and shorter overall LOS (median 41 h vs. 54, p < 0.001). Pediatric verified and non-pediatric verified trauma centers had similar rates of ICU admission (36.8% vs. 38.9%, p = 0.11).

Conclusion: Further work is needed to capture opportunities for reduction in ICU utilization in isolated BLSI.

Level of evidence: III.

Keywords: AbbrevIated injury score (AIS); Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC); Blunt liver and spleen injury (BLSI); Intensive care unit (ICU); Length of stay (LOS); National trauma data bank (NTDB); Non-operative management (NOM).