Hospital-based intervention is rarely needed for children with low-grade blunt abdominal solid organ injury

Infographic · Jan 2022 · 1 min read

In brief

Analysis of over 1,000 children with low-grade blunt solid organ injuries found that while 97% were admitted to inpatient units, only 1.7% required intervention for hemorrhage. These findings challenge routine hospital admission practices and suggest emergency department discharge may be safe for selected low-grade injuries.

Only 1.7% of children with low-grade blunt solid organ injury required intervention, with most occurring on hospital day 1
96.8% of low-grade SOI patients were admitted despite low intervention rates, suggesting potential for safe outpatient management
No child requiring angiography had abnormal ED shock index or needed transfusion, questioning current intervention criteria
Median hospital stay was 2 days with 23.9% ICU admission rate for injuries that rarely required hospital-based treatment
Current practice of routine inpatient admission for low-grade SOI may be unnecessary; ED discharge warrants prospective study

Written by the GCMD Library team from the infographic.

The infographic uses a hospital icon at top center with red and gray color scheme. Left side shows a gray figure with red trauma indicators on the abdomen, followed by inclusion criteria text. Right side displays three medical intervention icons (IV bag, internal organs, surgical instrument) in gray with green accents, each with corresponding percentage data beneath.

Background: Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs).

Methods: A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization.

Results: A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index.

Conclusion: Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management.

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