Reducing scheduled phlebotomy in stable pediatric patients with blunt liver or spleen injury.
OBJECTIVE
Although consensus-based guidelines exist for managing pediatric liver/spleen injuries, optimal phlebotomy frequency is unknown. We hypothesize surgeons order more phlebotomy than necessary and propose a pathway with one blood draw, early ambulation and discharge, fewer ICU admissions, and physiology-driven interventions.


METHODS
Records of 120 children with solid organ injury from two hospital registries (2008-2012) were analyzed. We compared resource utilization between our current management and management if the proposed pathway were in place. Paired t-test was used for statistical analysis.


RESULTS
Sixty-one patients were included (35 spleen, 22 liver, 4 combined). Average age was 11.6 (±4.2) years, injury severity score 9 (±5), and median injury grade 3. 51% of children were admitted to the ICU. Average phlebotomy per patient was 5 (±2) and length-of-stay 4.3 (±1.5) days. Three patients became unstable and required transfusion. No patients required operation or angioembolization. Our pathway would decrease ICU admissions by 65% (p<0.001), blood draws by 70% (p<0.001), and length-of-stay by 37% (p<0.001), while identifying all patients requiring transfusion based on hemodynamic status.


CONCLUSIONS
Our data suggest that clinical parameters could identify patients requiring intervention and decrease resource utilization. This suggests that serial phlebotomy may be unnecessary, and the proposed pathway is worthy of prospective validation.
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Jamie
J
Golden
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Ian
I
Mitchell
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Sally
S
Kuzniewski
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Aaron
A
Lipskar
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Jose M
JM
Prince
North Shore University Hospital, Manhasset, New York.
Matthew
M
Bank
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York.
Steven
S
Stylianos
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York. Electronic address: NRosen@NSHS.edu.
Nelson G
NG
Rosen
D000293:Adolescent; D001803:Blood Transfusion; D002648:Child; D019091:Critical Pathways; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008297:Male; D010359:Patient Readmission; D018962:Phlebotomy / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*
Liver injury; Pediatric; Phlebotomy; Resource utilization; Spleen injury