Update Course Rewind: Updates in Solid Organ Injury Management 2023

In resource-constrained settings like Uganda, grade 4 splenic laceration patients would be placed in ICU due to limited monitoring capacity on the floor, where there may not be monitors and minimal staff.

Management of splenic lacerations is a reflection of available resources; ICU admission decisions differ between resource-constrained and well-resourced settings.

APSA guidelines include four basic categories for solid organ injury management: where patients should be admitted, procedures, when to discharge them, and what to do after discharge.

In kids, the data doesn't support the need for angioembolization, even if you see active arterial extravasation on CT.

APSA guidelines indicate discharge when patients are clinically doing well, with no indication for repeat imaging after discharge.

Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity.

Cincinnati Children's Hospital guideline states only hemodynamically abnormal patients go to the ICU.

Cincinnati has started discharging isolated grade 1 or 2 splenic injuries from the emergency department.

In a study of grade 1 and 2 injuries with no other major organ injured, not a single patient got an intervention during hospitalization, including transfusion.

Grade 1-2 injuries are discharged from ED if patients are watched for 4 hours and able to tolerate a PO challenge.

CT scanning serves two purposes: making a diagnosis overall and determining appropriate discharge activity restrictions, which differ between splenic laceration and small bowel contusion.

In the blunt abdominal trauma guideline at Cincinnati, not all patients are scanned; AST and lipase are used to decide who needs a scan.

Standardized discharge instructions are created and given to all patients in collaboration with the emergency department.

Every patient discharged with solid organ injury is seen in trauma clinic within the week to ensure the child is doing well and to provide continued counseling about activity restrictions.

At the Utah practice, 80% of pediatric trauma patients are transfers and most have already had a CBC at the referring hospital.

For hemodynamically normal children with solid organ injury going to the floor, CBC is not repeated.

Data suggests that patients more likely to fail non-operative management have an initial hemoglobin less than 9.25.

Cincinnati protocol: if initial hemoglobin is less than 9.25, patient gets one repeat hemoglobin; if greater than 9.25, no repeats unless clinically indicated.

Contrast-enhanced ultrasound for grading solid organ injuries is not done routinely because radiologists and ultrasonographers comfortable with the technique are not available at 2:00 in the morning.

Contrast-enhanced ultrasound has not been found to be very reliable yet as an alternative to CT for solid organ injury grading.