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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 Tools

APSA 2019 Solid Organ Injury Guidelines

Key References

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.

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