P2D331: Management of Blunt Solid Organ Injuries in Children

Background: The management of blunt solid organ injury (BSOI) in children is costly and involves high utilization of in-hospital healthcare services. The American Pediatric Surgical Association (APSA) has published guidelines, updated in 2019, to standardize the management of liver and splenic BSOI in this population and to decrease length of stay (LOS), unnecessary intensive care unit (ICU) admissions, repeat imaging, lab utilization, transfusions, and withheld nutrition. Using the Pediatric Health Information System (PHIS) database, we aimed to identify practice differences before and after publication of the 2019 APSA BSOI guidelines across 47 children’s hospitals in the US.

Methods: Children with BSOI discharged between January of 2016 and December of 2021 were identified within the PHIS database using ICD-10 codes. Those with isolated liver or splenic injuries were included. Data from 2019 were excluded as a washout period. Descriptive statistics were used to report injured organ, ICU admission, LOS, diet status, transfusions, lab utilization, surgical or interventional radiology (IR) procedures, and imaging obtained. Comparison between pre- and post-guideline publication data were performed using Chi Square and T test.

Results: A total of 3,795 children met the inclusion criteria. Of those, 2,151 (56.7%) were admitted prior to the publication of the 2019 APSA guidelines. When compared to children admitted prior to the publication of the 2019 APSA BSOI guidelines, those admitted after the publication were less likely to be admitted to the ICU, less likely to have a diet withheld for greater than 24 hours, or receive a blood product transfusion. However, there has been no significant change in LOS, lab utilization, OR or IR procedures performed, or follow up imaging obtained (Table 1).

Conclusion: In this first evaluation of its kind, publication of the APSA guidelines for BSOI management in children in 2019 was associated with a decrease in a number of important metrics for resource utilization; however, there was no change in others. These findings offer further opportunities for guideline and quality improvement which may also have the added benefit of improved resource utilization.