USE OF A STATEWIDE SOLID ORGAN INJURY PROCOTCOL TO OPTIMIZE TRIAGE, TREATMENT, AND TRANSFER FOR PEDIATRIC ABDOMINAL TRAUMA.

Abstract

The Utah Pediatric Trauma Network (UPTN) is a non-competitive collaboration of all 51 hospitals in the state of Utah with the purpose of improving pediatric trauma care. Created in 2019, UPTN has implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. A blunt solid organ injury (SOI) protocol was developed to optimize treatment of these injuries statewide. The purpose of this study was to review the effectiveness of the SOI guideline. The UPTN REDCap® database was retrospectively reviewed from 2021 through 2022. We compared admissions from the Level 1 pediatric trauma center (PED1) to non-pediatric hospitals (non-PED1) of children with low grade (I-II) and high grade (III-V) SOIs. In 2 years, 172 patients were treated for blunt SOI, with or without concomitant injuries. There were 48 (28%) low grade and 124 (72%) high grade SOIs. 33 (69%) patients were triaged with low grade SOI injuries at a non-PED1 center, and 17 (35%) were transferred to the PED1 hospital. Most had multiple injuries, but 7 (44%) were isolated, and none required a transfusion or any procedure/operation at either hospital. Of the 124 patients with high grade injuries, 41 (33%) primarily presented to the PED1 center, and 44 (35%) were transferred there. Of these, 2 required a splenectomy and none required angiography. 39 children were treated at non-PED1 centers without transfer, and 4 required splenectomy and 6 underwent angiography/embolization procedures. No patient with an isolated SOI died. Implementation of SOI guidelines across UPTN successfully allowed non-pediatric hospitals to safely admit children with low grade isolated SOI, keeping families closer to home, while standardizing pediatric triage for blunt abdominal trauma in the state. III - Retrospective study.