title: Follow up of prospective validation of an abbreviated bedrest protocol in the management of blunt spleen and liver injury in children.
abstract: OBJECTIVE
  Current APSA recommendations for blunt spleen/liver injury (BSLI) entail bedrest equal to grade of injury plus one. We reported our experience 3 years ago with a prospectively implemented abbreviated protocol, one concern of which was that more numbers would be needed to support the safety of such a protocol. We are now reporting the final experience with this protocol as we move forward with further investigation.
  
  
  METHODS
  Following IRB approval, data were collected prospectively in all patients with BSLI up to 8 weeks after discharge. There were no exclusion criteria, and patient accrual was consecutive. Bedrest was restricted to one night for Grade I & II injuries and two nights for Grade ≥ III.
  
  
  RESULTS
  Between 11/2006 and 10/2012, 249 patients were admitted with BSLI. Mean age and weight were 10.3±4.8 years and 40.1±19.8 kg, respectively. Injuries included isolated spleen in 130 (52%), liver only in 107 (43%), and both in 12 (5%). One splenectomy was required for a grade V injury. Transfusions were used in 40 patients (16%), with 28 (11%) due to the injured solid organ. Bedrest for solid organ injury was applicable to 199 patients (80%), for which the mean grade of injury was 2.7±1.0 and mean bedrest was 1.6±0.6 days, resulting in 2.5±1.9 days of hospitalization. The need for bedrest was the limiting factor for length of stay in 155 patients (62%), for which mean grade of injury was 2.5±1.0 and mean bedrest was 1.6±0.6 days, resulting in 1.7±0.8 days of hospitalization. There were 4 deaths, 3 from brain injury and 1 from grade V liver injury. There were no patients readmitted for complications of solid organ injury.
  
  
  CONCLUSIONS
  These data further validate that an abbreviated protocol of one night of bedrest for grade I and II injuries and two nights for grade ≥ III can be safely employed, resulting in dramatic decreases in hospitalization compared to the current APSA recommendations.
authors: The Center For Prospective Clinical Trials The Children's Mercy Hospital Kansas City, MO.
authors: Shawn D
authors: SD
authors: St Peter
authors: Pablo
authors: P
authors: Aguayo
authors: David
authors: D
authors: Juang
authors: Susan W
authors: SW
authors: Sharp
authors: Charles L
authors: CL
authors: Snyder
authors: George W
authors: GW
authors: Holcomb
authors: Daniel J
authors: DJ
authors: Ostlie
mesh_terms: D000293:Adolescent; D001510:Bed Rest; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000628:therapy*
keywords: Blunt liver injury; Blunt spleen injury; Pediatric; Prospective