A Protocol Driven Approach to Reduce Lengths of Stay for Pediatric Blunt Liver and Spleen Injury Patients.

Abstract

Our institution updated blunt liver and spleen injury (BLSI) protocols in 2019 in adherence to updated American Pediatric Surgery Association (APSA) recommendations. This retrospective study compares resource utilization for pediatric BLSI patients treated under old and updated guidelines. BLSI patients without severe non-abdomen injuries aged under 18 treated with prior (04/2015-06/2019) and updated (06/2019-12/2022) guidelines were retrospectively reviewed and compared. Each patient received an adjusted injury severity score (ISS) to control for non-BLSI injuries. Multivariate analysis examined protocol group differences while controlling for adjusted ISS and BLSI grades. Primary outcomes were ICU length of stay (LOS), hospital LOS (analyzed using Cox regression), and patient costs (linear regression). Secondary outcomes include readmission in two weeks and death rates (logistic regression). 176 and 170 BLSI patients were treated with old and updated protocols, respectively. Patient demographics, average BLSI grade, and adjusted ISS were similar in both groups. Patients treated with old protocols indicate decreased hazard, showing significantly more days before ICU discharge (coefficient = -0.3868, p < .0009) and hospital discharge (coefficient = -0.5507, p < .0001). Patient costs (coefficient = 0.0921, p = 0.1874) trend towards being lower in the new protocol. Readmission rates were significantly higher in the new protocol (coefficient = -1.1731, p = 0.0465), and death rates (coefficient = 0.0519, p = 0.9710) were comparable. BLSI patients treated under new APSA guidelines compared to old guidelines had significant decreases in ICU and hospital LOS, a decreasing trend in costs, comparable death rates, but higher readmission rates. Future studies with larger sample sizes and detailed cost analysis would explore whether updated guidelines reduce patient costs and help elucidate the veracity or potential cause of the increased readmission rates. Level III, Therapeutic/Care Management.