Outcomes of an accelerated care pathway for pediatric blunt solid organ injuries in a public healthcare system

Infographic · Oct 2018 · 1 min read

In brief

Accelerated care pathway for pediatric blunt solid organ injuries reduced hospital stay from 5.6 to 3.4 days (saving $5,966 per patient) while maintaining safety. Protocol enabled earlier mobilization and fewer blood draws without increasing operative interventions or complications.

Accelerated care pathway reduced hospital stay by 2.2 days (5.6 to 3.4 days) for pediatric blunt solid organ injuries without increasing complications.
Protocol implementation saved average $5,966 per patient through shorter LOS while maintaining safety with no difference in operative intervention rates.
Early mobilization and fewer blood draws were achieved post-protocol without compromising detection of treatment failures or need for embolization.
ISS and protocol adherence independently predicted LOS; pathway is safe across injury grades in level one pediatric trauma centers.
Non-operative management success rates remained unchanged, demonstrating accelerated pathway does not compromise clinical outcomes or patient safety.

Written by the GCMD Library team from the infographic.

A three-panel infographic with a mint green background. Each panel contains a black icon (running figure, syringe, hospital building with calendar) on colored backgrounds (dark teal, light teal, gray-blue). Arrows indicate before-and-after comparisons. The Journal of Pediatric Surgery logo appears in the top right corner.

Purpose

An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed.

Methods

Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest.

Results

138 patients with solid organ injury were studied: 73 pre- (2012–2014) and 65 post-protocol (2014–2015). There were no significant differences in age, gender, injury severity score (ISS), injury grade, or mechanism (p > 0.05). LOS was shorter post-protocol (mean 5.6 vs. 3.4 days; median 5 .0 vs. 3.0 days; p = 0.0002), resulting in average savings of $5966 per patient. Patients in the protocol group mobilized faster (p < 0.0001) and experienced fewer blood draws (p = 0.02). On multivariate analysis, protocol group (p < 0.001) and ISS (p < 0.001) were independently associated with LOS. There were no differences between groups in the need for operation, embolization, or transfusion.

Conclusion

An accelerated care pathway is safe and effective in the management of pediatric solid organ injuries with early mobilization, less blood draws, and decreased LOS without significant morbidity and mortality.