title: National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol.
abstract: OBJECTIVE
  Recent reports suggest that an abbreviated bed rest protocol (ABRP) may safely reduce length of stay (LOS) and resource utilization in pediatric blunt spleen and liver injury (BSLI) patients. This study evaluates national temporal trends in BLSI management and estimates national reduction in LOS using an ABRP.
  
  
  METHODS
  Pediatric patients (<18 years old) sustaining BLSI were identified in the Kids' Inpatient Database from 2000 to 2009. Yearly rates of injury and operative intervention were examined and stratified by type of injury. APSA guidelines and the reported ABRP were applied based on abbreviated injury score (AIS) and compared with actual LOS.
  
  
  RESULTS
  22,153 patients were identified. Over the study period, operative rates for spleen and liver injuries and overall mortality significantly declined: LOS=3.1 days (±1.6) and 2.7 days (±1.9) for spleen and liver, respectively. If APSA guidelines were followed, the rates were LOS=3.7 days (±1.1) and 3.4 days (±0.7), respectively. Application of the ABRP would result in LOS=1.3 days (±0.5) for all BSLI patients. An ABRP could potentially save 1.7 hospital days/patient or 36,964 patient hospital days nationally.
  
  
  CONCLUSIONS
  Our study confirms a significant national decrease in operative intervention and overall mortality in patients with BSLI. Additionally, it appears that a shorter observation period than the APSA guidelines is being utilized. The implementation of ABRP holds potential in further reducing LOS and resource utilization.
authors.affiliation: Wisconsin Surgical Outcomes Research Program, University of Wisconsin Hospitals and Clinics, Madison, WI.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Dodgion
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Ankush
authors.initials: A
authors.lastname: Gosain
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Nichol
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, Wisconsin. Electronic address: ostlie@surgery.wisc.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay / Q000639:trends; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods*; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*
keywords: Bedrest protocol; Blunt liver injury; Blunt spleen injury; Pediatric trauma