O3283: Unwarranted Intensive Care Unit Admissions in Pediatric Blunt Liver and Spleen Injuries: A National Trauma Data Bank Analysis

Background: Guidelines for blunt liver and spleen injury (BLSI) by the ATOMAC research consortium suggest that the majority of children who present with isolated blunt liver or spleen injury can be safely discharged home without ICU stay regardless of injury grade. In this study we examine the rates of ICU admission for children with isolated low risk spleen and liver injury among US hospitals.

Methods: We identified pediatric patients ages 15 and under admitted between 2017 and 2019 in the National Trauma Data Bank who presented with blunt liver or spleen injury. BLSI was considered isolated if the patient had only low severity ( < 3 AIS severity) concomitant non-abdominal injuries. Children were considered low risk if they presented with isolated BLSI; normal admission blood pressure, pulse rate, temperature, respiratory rate, and pulse oximetry; did not require angiography, embolization, or surgery during their hospital course; and did not require blood transfusion. Rates of ICU admission were calculated and comparisons were made between pediatric verified and non-pediatric verified trauma centers.

Results: 10,849 patients ages 15 and under presented with BLSI during the study period. 6,605 of these patients were considered isolated BLSI, and 1008/6605 (15.3%) were identified as low risk BLSI. Among these patients, 467 had liver injuries, and 570 had spleen injuries. 396/1008 (39.3%) were admitted to the ICU with an average length of ICU stay of 2.4 days. The average hospital length of stay for patients admitted to the ICU was 78 hours, and the average hospital length of stay for patients not admitted to the ICU was 34 hours (P < 2.2e-16). ICU admission rates were higher in pediatric verified trauma centers compared to non-pediatric verified trauma centers (42.5% vs 36.3%, P=.0432).

Conclusion: Despite evidence based guidelines for management of blunt liver and spleen injury in children, ICU admission rates remain unacceptably high in low risk, isolated injury. Further work is needed to change practices to avoid unnecessary ICU admissions.