Blunt Liver and Spleen Injury Pathway Background and Objectives Blunt abdominal trauma causing liver and/or spleen injury is one of the most common indications for hospital admission for injured children. In 2012, a pediatric trauma consortium, ATOMAC, developed a practice management guideline for blunt liver or spleen injury that is evidence-based and used at many pediatric trauma centers. More recently in 2019, the American Pediatric Surgery Association (APSA) Trauma Committee expanded this and developed non-operative management guidelines for blunt trauma to the abdomen to help standardize care. The objectives of this Connecticut Children’s clinical pathway for the management of blunt liver and spleen injury are to: Standardize care to decrease variability in the management of patients with blunt spleen and/or liver injury Decrease length of stay to conform with current evidence-based guidelines Decrease unnecessary laboratory testing Avoid unnecessary Pediatric Intensive Care Unit admissions Algorithm Download Blunt Liver and Spleen Injury Pathway Algorithm Quality Metrics Percentage eligible patients treated per pathway Percentage of eligible patients with order set usage Percentage of patients requiring red blood cell transfusion Percentage of patients for whom radiologist “graded” the liver/spleen injury Percentage of patients admitted to the appropriate location per pathway (PICU v. Med/Surg) Percentage of patients with hematocrit drawn at appropriate frequency per pathway Average length of stay (days) Educational Module Download Blunt Liver and Spleen Injury Educational Module Key References Acker SN, Petrun B, Partrick DA, Bensard DD. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children. J Trauma Acute Care Surg. 2015 Dec;79(6):991-994. Gates RL, Price M, et al. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019 Aug;54(8):1519-1526. Acierno, SP, Jurkovich, GJ, Nathens AB. (2004). Is Pediatric Trauma Still a Surgical Disease? Patterns of Emergent Operative Intervention in the Injured Child. J Trauma Acute Care Surg. 2004 May;56(5):960-4. McVay MR, Kokoschka ER, Jackson RJ, Smith SD. Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. J Ped Surgery. 2008 Jun;43(6):1072-6. Notrica DM, Eubanks JW, Tuggle DW, et al. Nonoperative Management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015 Oct;79(4):683-93. Pathway Contacts Brendan Campbell, MD, MPH Samantha Pelow, APRN Jen Tabak, RN, MSN Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
