The benefits of limiting scheduled blood draws in children with a blunt liver or spleen injury
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Read the article on jpedsurg.org ↗Article · May 2019 · 1 min read
In brief
In brief
This retrospective study demonstrates that limiting scheduled hemoglobin/hematocrit monitoring in pediatric blunt liver and spleen injuries is safe when clinical decision-making relies on vital sign changes rather than routine laboratory values. The protocol change reduced unnecessary blood draws without compromising patient safety or outcomes.
Written by the GCMD Library team from the article.
Background
Nonoperative management protocols of blunt liver and spleen injury in children usually call for serial monitoring of the child's hemoglobin and hematocrit (H/H) at scheduled intervals. We previously demonstrated that the need for emergent intervention is triggered by changes in vital signs, not the findings of scheduled blood draws and changed our protocol accordingly. The current aim is to evaluate the safety of this change.
Methods
We performed a retrospective review of all children admitted following blunt liver or spleen injury during two periods; the historic cohort 1/09–12/13 and the protocol cohort 8/15–7/17. Data evaluated included the need for intervention, number of H/H checks, and outcomes.
Results
330 children were included (216 historic; 114 protocol). Groups did not differ in percentage of male patients, injury severity score, or GCS. Median age in the historic cohort was younger than the protocol cohort (9 vs 12 years; p = 0.02). More children in the protocol group had a grade 5 injury (1% vs 9%; p